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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v V 0 / �Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ^� r <br /> 0 0 <br /> C <br /> TELEPHONE <br /> OWNER <br /> DuC/V-riN Z/M/`7CR�Yi AA) 7e 0 m <br /> HOME ADDRESS 0 o N L A K,L R J (I iWj_ 5Yg 9 <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROADNAME404A1 LAkI <br /> LEGAL DESCRIPTION(see tax receipt)J^jl�G r1O A/ / r w F' . Yo R1.5- Z-0 r ycSM (/ l P /f 7 0 b <br /> r <br /> o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE <br /> ADDITION- <br /> or <br /> CL <br /> 5. <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: Ir <br /> (Home/Cabin; Commercial Business; Bedroom;Dock;etc.) It <br /> 9 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 3 <br /> x C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m$ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). <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. <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. <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q E <br /> ISSUED. 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z I ' <br /> 0 <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. ;MUD g ck <br /> 6. v 3 C <br /> 7. o <br /> = i m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my E c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of CLm <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m i m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m 0 <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 JZ <br /> 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. T i <br /> o : <br /> m : <br /> SIGN HERE <br /> (V14514 of OW54pbuilding contractor) _, j 0aw <br /> ZONING ADMINISTRATOR H <br /> MN HH 414A <br /> In MUNI O ,fNJi O O <br /> 11 � ' illi O00 000 <br /> 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED I 1 <br />