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c0amp <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator a ci z <br /> APPLICATION FOR LAND USE PERMITS . = P <br /> OWNER ��J G �, �� TELEPHONE <br /> m <br /> c B <br /> HOME ADDRESS G� <br /> r <br /> EMERGENCY/FIRE NUMBER J..! SA1;1,G7_ ROAD NAME <br /> Z r �J <br /> LEGAL DESCRIPTION(see tax receipt) 00 co <br /> o <br /> c <br /> TYPE OF PERMIT(S):DWELLINGBUILDING GARAGEIACCESSORY STRUCTUREADDITION ''^^ <br /> 4 F� <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ( S <br /> O �I <br /> STRUCTURE/ADDITION USE: .G�/�iP/� `�' `� It <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). to .. 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 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- <br /> INGS, ROADS,LAKE, LOT LINES. eQ <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 U,) <br /> MUST BE SIGNED AND DATED BY THE OWNER. ro o <br /> t7 � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 4 S, W <br /> ISSUED. U) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z v l <br /> P ill <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 /> 3a ill'm <br /> v � C)n" m off ; <br /> 7. 0 i = M <br /> coi m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my E ZS E f ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o. <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- 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 <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. T i <br /> SIGN HERE �L96(slIgnature op6yfior or building contractor) (date) <br /> ZONING ADMINISTRATOR 1„ 1 m Flan I� <br /> e uuurww� <br /> N NU N N r n [n <br /> t T !A O N f T 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />