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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator g v Z <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> r <br /> w <br /> N <br /> OWNERBA TELEPHONE P��-.A� �-1�r nc�nl <br /> HOME ADDRESS 10 3 LL C(_E\je__k ND f Ty G . `S-- f"t�(— M W S5 0L <br /> �1 0 � <br /> EMERGENCY/FIRE NUMBER �� 1-2 ROAD NAME ff"#ft J _rPRj -- <br /> LEGAL DESCRIPTION(see tax receipt) �� �4�\ 9 CSM to <br /> SNS `r:5 �/ lI �R•+u CO 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/AC ESSORY STRUCTURE_6_.ADDITION c <br /> c <br /> S. <br /> LA. <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> �.n N <br /> STRUCTURE/ADDITION USE: Sro�PICC r <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) � <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR it <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O 5 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. z 2.. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m .. <br /> NORTH(N). 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, <br /> STREAM OR RIVER. (n a <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 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c <br /> t7 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 9 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c <br /> 1 <br /> 7. 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 /> 6. ){ � oae M <br /> it C <br /> _ E <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my rn i m g M <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a C <br /> all information contained In this application(including any accompanying schedule)and 1 further declare that I recognize <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determiningwhether to is- m M <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 pereo have access to the above described premises at any reasonable time for the purpose of inspection. n <br /> ig <br /> SIGN HERE — 10-q IO'`-�'( <br /> (signature of ow or or building contractor) (date) <br /> ZONING ADMINISTRATOR 1lYl ) '• `• `• <br /> � HHiRHHfA� <br /> N NNNNN Vt <br /> N N O pl fnOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED c c c c c c o <br />