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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ° o <br /> -0 o <br /> APPLICATION FOR LAND USE PERMITS a 4 <br /> r <br /> w <br /> N <br /> OWNER j TELEPHONE <br /> HOME ADDRESS <br /> / 7 O <br /> C f�el /l �LAV-V tel!f r i/ped U <br /> ,jam <br /> 0 <br /> EMERGENCY/FIRE NUMBER 5� ROAD NAME S e- <br /> .1 o <br /> ,[or I c5.M v H P z3 FrLi <br /> LEGAL DESCRIPTION(see tax receipt) <br /> AA 60V LOT- 1 (i, 1 ri+ %!S M t <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREADDITION v <br /> a <br /> 5. <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION cn <br /> m <br /> STRUCTURE/ADDITION USE: kas <br /> (Home/Cabin;Commercial usiness; edroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ."0 u <br /> DIRECTIONS FOR PLOT PLAN DRAWIN (AERIAL OR TOP VIEW) p o <br /> M a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0, q_.)ju <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, U� Z <br /> STREAM OR RIVER. o <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. 5- <br /> NOTE: <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEwa ? (� <br /> ISSUED. <br /> ty <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a V <br /> CONDITIONS OF PERMIT: g j <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 /> -6:,, b . <br /> 5. (tea+ �q r3 J�dS / o►n SIG+!Pr �1`P�/ <br /> J AM. m m W L I M <br /> 6. �(p� ` <br /> (1 N N Q� itl <br /> 9 C N � <br /> 7. Z : '" N� �f° � <br /> O <br /> C/) m <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 'm C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize io B <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- E o <br /> 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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinancer m <br /> authorized person to have access to thea ove des c bed premises at any reasonable a pf 1 m <br /> / mi <br /> SIGN -- Vii. <br /> ( nat re bf owner or wilding contractor) 0dat9Mf1R/ <br /> ZONING ADMINISTRATOR rim 3t <br /> TOWNSHIP PERMITS MAYBE REQUIRED <br />