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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator � Z <br /> APPLICATION FOR LAND USE PERMITS 4 ° <br /> �eoefnt5seJP o <br /> -�^ (715-) <br /> TELEPHONE y c <br /> OWNER Q�n l III 1 Q <br /> TELEPHONE d'� C <br /> • 00 <br /> ! 'Q 0677n7Pn-fi- <br /> HOMEADDRESS aQoi—I <br /> C+ O <br /> fj`e-t t{or1 <br /> EMERGENCY/FIRE NUMBER -7 ROAD NAME Po i ,t <br /> 1 I <br /> LEGAL DESCRIPTION(see tax receipt) W �1 L � S. G .T a42 I S j_d? /d <br /> 'T C rn <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ADDITION y <br /> c <br /> c <br /> CL <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> CA <br /> STRUCTURE/ADDITION USE: O/n <br /> a <br /> fiP <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -I <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR M <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3. <br /> DIRECTIONS FOR PLOT PLAN DAWIN - (AERIAL OR TOP VIEW) OM � r � <br /> / V \ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S <br /> NORTH(N). C ` n <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, <br /> STREAM OR RIVER. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- o <br /> INGS,ROADS, LAKE, LOT LINES. Z <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6.f IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o L <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a <br /> ISSUED. C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z O <br /> CONDITIONS OF PERM[ o <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 (t) <br /> PERMITTED. VV <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> 5. PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> s. s� •tR vd orv� 41 .4f-6C- A�- (eG a� 3 o V4- TYO,•• „ . <br /> R`// � 3 2L o rn <br /> 7. <br /> F me <br /> Zh " a <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of im g C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> 9 m 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 Burnett relying on this information I am <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other m <br /> m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. . . <br /> - <br /> SIGN HERE <br /> a� �7T <br /> (sign <br /> re f ownerr ilding contractor) (dam) <br /> ZONING ADMINISTRATOR <br /> NHKHHNN+ <br /> � NONtrOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 ig 0 0 0 0 0 <br />