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lJ' w <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator V ° o <br /> o <br /> APPLICATION FOR LAND USE PERMITS <br /> o <br /> fA <br /> OWNER Q r Y / TELEPHONE � (� 9� a <br /> HOME ADDRESS �n c cj S �/ tvR4 a O <br /> EMERGENCY/FIRE NUMBER a ROAD NAME C4c <br /> -S� la- <br /> LEGAL DESCRIPTION see tax receipt) SW ��..- 17 ca <br /> i� _ <br /> y <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> cc i n <br /> U <br /> n <br /> 5. <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> �� -^ 0, <br /> STRUCTURE/ADDITION USE: � 'v/ l�UU7f 1 P10 rcQ�1 <br /> (Ho n; Commercial Busines ;Bedroom;Deck;etc.) <br /> V <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. I <br /> x a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C Ci <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v v <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- l <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 v <br /> MUST BE SIGNED AND DATED BY THE OWNER. f c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 4 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z d <br /> CONDITIONS OF PERMIT: ° <br /> I <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 - mm 0 a <br /> a two :in cm3 <br /> 7. Zi '^ o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; p <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> m C <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognize ' mp <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 abov described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> m : <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) i <br /> ZONING ADMINISTRATOR 7;:jT. <br /> ' N <br /> (AWNNN tn <br /> N N <br /> N OP fr1P PP <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />