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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 64872 Office of Zoning Administrator R c a <br /> APPLICATION FOR LAND USE PERMITS a <br /> ^� r <br /> C <br /> OWNER V/eE(go R�j ©M AN TELEPHONE 6/,2 -861— 64 G <br /> p n %� Ir O <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) sgO R.48 T,5_ C <br /> C <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION- <br /> 4: '1 <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT-ffSyyU��BDIVISION <br /> Le. (� <br /> STRUCTURE/ADDITION USE: OR,2J4 6 I 4a- 'OALA G F. A//��//40' <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> � Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. am ms jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO fD v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. p <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- W <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z d <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r n' <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 /> �. q$ a 1 m <br /> 6. a Raow �m3 <br /> 7. Z a �l <br /> o . <br /> mE i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS g A <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Q E o o fi E '• <br /> that this Information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ; d O <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T i <br /> N : <br /> M : <br /> SIGN HERE ) ��9/ N ' <br /> (signature of owner or building contractor) (date) <br /> - m1ri <br /> ZONING ADMINISTRATOR gy ' N <br /> NNNNNNN� <br /> tN7i fN7iO NfN7�00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ° 0 0 0 0 0 0 <br /> 0000000 <br />