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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c) z <br /> APPLICATION FOR LAND USE PERMITS . 4 f� <br /> 0 nn ,, <br /> M m » HCl <br /> OWNER ✓r0��..� l � TELEPHONE6/2- 77a <br /> m <br /> HOME ADDRESS']6(�.j yL Gzg� 5�� v — 0 <br /> EMERGENCY/FIRE NUMBER �9 q ROAD NAME �ftae;CX � l <br /> LEGAL DESCRIPTION(see tax receipt) R. �4, S ( � I m <br /> 1b w <br /> TYPE OF RMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION CXj c <br /> a <br /> N� v <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> ca <br /> 91 <br /> STRUCTURE/ADDITION USE: to <br /> ome/ a m; om ercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> >A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> ?I z <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 C t7 <br /> NORTH(N). N 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. <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. Cj <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. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEq 0 <br /> ISSUED. 2 <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: 70 <br /> 1 <br /> 1 <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 /> -6. mom oeom <br /> Ck t3�t�3FQ <br /> 7. o i N (D <br /> i i i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my a5 c p <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 !� m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsinjkl <br /> ++u��jjjj hether to is- m t7 <br /> sue a permit. I further accept all liability which may be a result of the f elf� nation I am m <br /> providing in this application. I agree to permit county officials chart a 1 i as or other <br /> authorized person to have access to the above described premises at urpos o Inspection. -n <br /> m i <br /> SIGN HERE a ` R H <br /> ignatu-re of owner orrbuilding contractor) (d <br /> eY <br /> ZONING ADMINISTRATOR 1YPYfi BURNCr COUNTY <br /> ZONIN NNfHJNN�� <br /> v N V1 O frl O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 000 9000 0 0 0 <br /> 0 00 <br />