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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> w 0 s <br /> w <br /> IL <br /> C r <br /> \' <br /> OWNER TELEPHONE <br /> O <br /> HOMEADDRESS �q <br /> 1I <br /> EMERGENCY/FIRE NUMBER 3C)a6 ROADNAME OT j} ki\SONj i <br /> LEGAL DESCRIPTION(see tax receipt) S— <br /> N o 7 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION aC� <br /> w' Q <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> u] <br /> ! m <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR I <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWINGa (AERIAL OR TOP VIEW) n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m e <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> y <br /> 3. SOW DIMENSIONS). M 1.00 <br /> IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO NORTH(N <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> 0 <br /> STREAM OR RIVER. <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. SID <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 f <br /> MUST BE SIGNED AND DATED BY THE OWNER. ' V <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE c <br /> ISSUED. C1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: C"�n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> V, <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 C� <br /> PERMITTED, <br /> OF THE OHWM OF LAKES, <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. m ,9o0ir <br /> C <br /> 6. E 'Rmo : � o <br /> Z <br /> `" (q : <br /> 7. 0) E <br /> rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Z5 c A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of CL <br /> 0 <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 ° <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. <br /> m : <br /> SIGN HERE ' <br /> ( n ure of owner b Iding contractor) (date) i <br /> ZONING ADMINISTRATOR <br /> �WhH <br /> � tr NON O <br /> 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 <br />