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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'U 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> w o <br /> OWNER00�eac( C a"T TELEPHONE <br /> ] am <br /> Q97� <br /> HOME ADDRESS <br /> r 90 <br /> EMERGENCY/FIRE NUMBER -ROAD NAMELiWif, Qd^ \ <br /> �J <br /> LEGAL DESCRIPTION(see tax receipt) f � co y <br /> i <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREADDITION it ' <br /> r <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> �a l � <br /> STRUCTURE/ADDITION USE: ' Ea <br /> (Home/Cabin; Commercial Busines ,Bedroom;Deck;etc.) /)(got <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a 'a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE c n <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a <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- J <br /> INGS, ROADS, LAKE, LOT LINES. <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 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> o 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 <br /> ISSUED. Ft <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z S <br /> CONDITIONS OF PERMIT: P <br /> t <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 /> 3 a6. RL n <br /> v 9000 O7. <br /> � <br /> _rn S m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my E g A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofo g ; S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. T E <br /> CD : <br /> �i�,41w Y / m <br /> SIGN HERE /' t!(` �i� �� � /Q 7 � . <br /> (signatu owner or building contra (date) <br /> -41n I <br /> ZONING ADMINISTRATOR <br /> w w ur <br /> NNTv <br /> V1 41N NTOWNSHIP PERMITS MAY BE REQUIRED o 0 <br />