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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS s 4 <br /> r ' <br /> N 1 <br /> OWNER TELEPHONE aV <br /> m <br /> OC <br /> HOMEADDRESS <br /> EMERGENCY/FIRE NUMBER 3 U S ROAD NAME <br /> I <br /> Loi . ce C,U <br /> LEGAL DESCRIPTION(see tax receipt) `L f�Csm. Vol, (o P a�3 /,p 7L�6�_� lgbl S — <br /> / / o <br /> y 7 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ARAG ACCESSORY STRUCTURE k ADDITION_ C <br /> Cr <br /> n <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> /' y <br /> STRUCTURE/ADDITION USE: l3�'YGt�'i� (,[ �LUY-1 <br /> (Home/Cabin; Commercial Business; 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. <br /> 0 in C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) TIn e <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m W � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rnIr <br /> NORTH(N). o <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- 1 <br /> INGS, ROADS, LAKE, LOT LINES. I :� <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o TZ <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a <br /> ISSUED. St <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1 <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. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V <br /> PERMITTED. (� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, v <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> Z <br /> rt <br /> 6 'aC" S3 <br /> 9tmo Baa <br /> 7. Z : F (Q : .t <br /> P <br /> =y : rt <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y C <br /> sue a permit. 1 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 Pers have acc s to Te above described premises at any reasonable time for the purpose of Inspection. m <br /> SIGN HERE <br /> (signature o owner or building contractor) (date) <br /> ZONING ADMINISTRATOR V I Y� �toq\It w <br /> �4040404040� <br /> N Nin N Nfn (n <br /> V• V7O Vt (nOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />