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&'`�' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator $ 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 < <br /> ar- rD <br /> 0 <br /> OWNER CCa%5 TELEPHONE(612.) 483-8081 n -2) <br /> C rv%a%h.%-)) <br /> d <br /> HOMEADDRESS 6`+00 Oeet radafl �u�� / �,tio 1p.Kes MNSJ O) y � (Jl 0 <br /> we <br /> EMERGENCY/FIRE NUMBER ROAD NAME �� L '✓?O 7 �� <br /> r,oT4 404ry/C.5 W V 15- F35- <br /> LEGAL <br /> 3sLEGAL DESCRIPTION(see tax receipt) F E N4ay P2 T "-t 3 CS r V1 1 CL <br /> P '1W -GOV`+ "TS 4 a5 _ <br /> m <br /> `0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION Cn� <br /> a 1 <br /> 5. n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0. <br /> V) <br /> \/ <br /> STRUCTURE/ADDITION USE: I Y <br /> (Home/Cabin; C mmercial Business; Bedroom;Deck;etc.) 3 -{ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER, ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> ;a <br /> DIRECTIONS FOR PLOT PLAN DRAWING7 (AERIAL OR TOP VIEW) O o <br /> -I a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN To SCALE. ° <br /> 2 SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m O <br /> O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m O 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 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. <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 c U <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 3 0 <br /> ISSUED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. oZ C <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT a yJ <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 v <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 /> �. m <br /> m <br /> s. C 0=3. 3 <br /> CC <br /> 7. <br /> P : .0 <br /> _w: : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my � �c � pm <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of uQ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> SIGN HERE 40 <br /> (sl at re of owner or ui ing contractor) (data) <br /> ZONING ADMINISTRATOR <br /> �40 40 40 <br /> N Nfn NN(7T UI <br /> N utOutNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />