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V ' , <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator V o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> w o <br /> OWNER TELEPHONE <br /> COEl v- L--YT � <br /> m <br /> HOME ADDRESSeir- J I <br /> o <br /> V 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME ® O <br /> C Z([-74? PNS s2�/ � ' j � <br /> LEGAL DESCRIPTION(see tax receipt) /y� �Q d'P I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREbN ADDITION Cr <br /> 5: <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> le c / C <br /> STRUCTURE/ADDITION USE: ! �YL P� /P!!� t�� 6i <br /> •e � <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T ii <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 0 <br /> NORTH(N). W ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m p <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. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. to <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 <br /> ISSUED. 2 1 <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. <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 /> �'. a La: ; <br /> 6. aCw N o <br /> 9i m o <br /> w <br /> 7. c <br /> _cn .. <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Z5 g C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ; o ; <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- m v <br /> sue a permit. I further accept liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this application. I gree to permit county officials charged with administering county ordinances or other J E <br /> authorized person to have ss to the bove described premises at any reasonable time for the purpose of Inspection. n <br /> m : <br /> SIGN HERE <br /> (signa�f or building contractor) (da*) <br /> ZONING ADMINISTRATOR InrrI � f^ <br /> H N N H J <br /> N fl1NN V1 ut <br /> NO°i to 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />