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G <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> N O <br /> m <br /> C e\ <br /> (D vJ <br /> / O. <br /> OWNERR!4 ,re TELEPHONEro <br /> HOME ADDRESS 7o e1 4�im <br /> EMERGENCY/FIRE NUMBER 7089 ROAD NAME C 1 <br /> ( P) NO ' l ) a) ��� L ( 1 0 <br /> LEGAL DESCRIPTION see tax recei t y <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> U) <br /> Gs <br /> STRUCTURE/ADDITION USE: m <br /> (Home/Cabin; Comme Business; Bedroom; Deck; etc.) v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR _n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> .0 in <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> Z! O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(N). y o <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 AND MEASUREMENT TO WETLAND AREAS. P <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 1 <br /> 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ' o <br /> jj <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. CjQ <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. A v C)r- O Da O 'a <br /> 6. CD <br /> v� mcmFo �' _ <br /> 3 <br /> Z w m _0 <br /> � <br /> 7. <br /> O <br /> = <br /> C/) : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y a <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 per unty officials charged with administering county ordinances or other m <br /> authorized person to have access to the abo a cribed premises at any reasonable time for the purpose of inspection. n <br /> CD : <br /> m : <br /> r <br /> v+ <br /> SIGN HERE <br /> (sig 6 ke. <br /> owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> NN N N N U U <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />