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' Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator on o l <br /> 0 <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> OWNER � TELEPHONE o iGhd�� EGl{i�r�fl �Da1- a u o <br /> � `, <br /> HOME ADDRESS <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> d JW I <br /> LEGAL DESCRIPTION(see tax receipt) ��� �� r D� atm �R <br /> v <br /> !n 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION c ' <br /> CL <br /> S 1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> e��m V. �� P, 10k is llu <br /> y <br /> STRUCTURE/ADDITION USE: if <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) 'a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m Sit <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 �f <br /> ;a C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'q <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y 3 <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. c <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. 95 <br /> c I 1 <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. Ln <br /> c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. 0 <br /> I I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <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. ii qq <br /> $ 3 ain '.F2. � <br /> o " Hal 6. p o 0S _, <br /> r. <br /> C N . 0 <br /> 7. o : fe (D �� � <br /> : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Gej c ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 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 : t7 <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 E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ; CD <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> CD : <br /> o <br /> 40 <br /> SIGN HERE <br /> (signature of owner or building contractor) (date)ro <br /> ZONING ADMINISTRATOR �11(Y� i c-1n)gd71 . . . . . . <br /> fnwwwww�' <br /> N N 01 <br /> Vt (T O V1 p1 0 0 <br /> o 0 0 0 0 0 o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />