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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 Z <br /> APPLICATION FOR LAND USE PERMITS 4 ° <br /> } (a <br /> OWNERTELEPHONE PL <br /> A I✓r d !� �S hAA �' 9�� 3 �D� a <br /> HOME ADDRESS 0 <br /> 9 O <br /> 1 S4 1 <br /> o � <br /> EMERGENCY/FIRE NUMBER (�/� n� ROAD NAME 1.1 mP <br /> LEGAL DESCRIPTION(see tax receipt) Lo-r 1 v), &r V`f P c�CS(7 ! — q 1405 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING�_GARAGE/ACCESSORY STRUCTURE ADDITION C <br /> c <br /> Cr <br /> CL <br /> S. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0' <br /> LL �� ( y <br /> STRUCTURE/ADDITION USE: Ca-b' f] ��C(// t/ � jl ff <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) -i <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O n; C <br /> x <br /> DIRECTIONS FOR PLOT PLAN DWIN - (AERIAL OR TOP VIEW) <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. M C Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m .. 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. I c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 <br /> ISSUED. 3 <br /> Cal) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z .. <br /> CONDITIONS OF PERMIT: c <br /> 4 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. �� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLO — 7tT 5"FEET'OF OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. I <br /> ��pp + M 9 t7 r• l7�l7 � <br /> 6. SGr � � l � �. mm <br /> 1.190HU � <br /> 7. I� . . Jl. ZE wm� 'IPS <br /> .! t.t y i <br /> I declare that this application(including any accompanying schedu e) has been o the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge a am responsible for the detail and accuracy of m ` ` C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C w ; m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burne on this Information I am <br /> providing in this application. I agree to permit county officials charged with adminisR�urf nate ; <br /> ro <br /> authorized person to have access to the above described premises at any reasonable t e the pur'ose of it dv's�i <br /> SIGN HERE r'� .rr f^ <br /> r <br /> (sign re owner or Iding contractor) (dike <br /> ZONING ADMINISTRATOR 1 ;' <br /> dsw4eww h <br /> N N V7NN N <br /> UI V•O ut N <br /> TOWNSHIP PERMITS MAY BE REQUIRED _'- 0 0 0 0 0 <br />