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6) rinml� <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS a 4 <br /> ///� r Haven <br /> OWNER (l Cj 7��. L/� /'/ CL/9�c�f1/ TELEPHONE -7,L5--ty?;6` 7o"Z 1 6 o <br /> S O <br /> HOME ADDRESS 7 7a q f/oS�CG� 6J✓G Qn�n�!/ �f� -G <br /> EMERGENCY/FIRE NUMBER G�e ROAD NAMErj <br /> LEGAL DESCRIPTION(see tax receipt) Lir �' �l I / I I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE _ADDITION 0) <br /> a <br /> a' <br /> SANITARY PRIVYFILLIN RADING CAMPING UNIT SUBDIVISION !� <br /> N <br /> �,yy�� !� <br /> STRUCTURE/ADDITION USE: rl KRE _ 6 = f� <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <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. <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) 0 $ Q <br /> z <br /> t. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S +q <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C .. ` O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. � 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. i; O <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 /> ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 ?, <br /> ISSUED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. �V't <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.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> / ] 9 <br /> a <br /> . E 91 <br /> w <br /> o : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cp <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Em ` '• C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize In <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am ? m' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m : E <br /> H <br /> SIGN HERE le <br /> (slyi yi townaror un gcontreetor) JJJ, (date) �J <br /> ZONING ADMINISTRATOR (/ - ' H <br /> HHH NMN <br /> N NOrNnQ 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRE <br />