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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0z <br /> • APPLICATION FOR LAND USE PERMITS 3 4 <br /> N 0 <br /> o41- <br /> ,41 <br /> 2 <br /> CL <br /> OWNER �'ATh/%4S / �LGa�GTELEPHONE M�G�/.�) <br /> HOME ADDRESS�y f WEsT G d- /`�d• �� �OSG-!/{�/� / /jv, 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME e;Q,VSayV *�O, ) �1 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION_X m <br /> 0 <br /> C <br /> CT <br /> B: <br /> S. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> w <br /> STRUCTURE/ADDITION USE: CABIN <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 (� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O r. <br /> x c <br /> DIRECTIONS FOR PLOT PLAN D AWIN ' (AERIAL OR TOP VIEW) p <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 0 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ^I <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. S c <br /> v � } <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q o <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c <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.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> m � om <br /> a <br /> 6. Cw0 <br /> w ; <br /> � <br /> 7. Z : �w <br /> o i r'0 <br /> yi i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c E i ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i 22 m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m M <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 coun ordinances or other i <br /> authorized person to have access to the above described premises at any reasonable time foF- dipose- 6f1ft5peMm-. ; i <br /> SIGN HERE y1 j <br /> (sin re of ow or building contractor) <br /> ` IV41906i <br /> ZONING ADMINISTRATOR v)n 1lora-la- <br /> TOWNSHIP <br /> cel TOWNSHIP PERMITS MAY BE REQUIRED <br />