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C <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,W1 U872 Office of Zoning Administrator o cl <br /> APPLICATION FOR LAND USE PERMITS XJ <br /> OWNER i C��C�I,r� � TELEPHONE l[JI �('u—.��CJy Y (� <br /> �^ `�� _ �Jc y�n I � O <br /> HOME ADDRESS �� IC t l�`J R�i ld�U ��� Y//IJ Y 11/ o <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) SE --Se ��` � 7qQN <br /> y o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE <br /> ADDITION cr <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION Y✓ Z <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; edroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 00 <br /> DIRECTIONS FOR PLOT PIAN DRAWING: (AERIAL OR TOP VIEW) T <br /> ?I O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N c <br /> NORTH(N). m 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO <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. <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 �. <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE C E -C <br /> ISSUED. <br /> Z O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° <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. <br /> 6. <br /> a wm0N0jp -i <br /> P <br /> �1 <br /> 7. =0: i i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i 8 9 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> Lr <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize O 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 E E <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <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 /> (signature of owner or building contractor) (date) �ry <br /> ZONING ADMINISTRATOR 'VVON"t 0d000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 �t <br />