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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator OL <br /> Z <br /> APPLICATION FOR LAND USE PERMITS ° <br /> r <br /> OWNER <br /> :Liar S� TELEPHONE CL <br /> w <br /> —� <br /> �}J <br /> HOMEADDRESS IfjIS I 0 <br /> V 1 I� O <br /> 1 � <br /> r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME 1 <br /> LEGAL DESCRIPTION(see tax receipt) 5 1_ 1 [ J r <br /> W S ��— 7 —�� <br /> uJ� <br /> n � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION C <br /> cr <br /> a <br /> S. (1 1 <br /> SANITARY PRIVY FILLINCG/GRADING1 / CAMPING UNIT SUBDIVISION La. <br /> STRUCTURE/ADDITION USE: `� v I P. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) c'D 1 [� <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n. <br /> DIRECTIONS FOR PLOT PLAN DRAWING. (AERIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. v Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S <br /> NORTH(N). <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(OHW <br /> STREAM OR RIVER. M)OF LAKE, <br /> Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- o <br /> INGS, ROADS, LAKE, LOT LINES. P <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 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q 0 <br /> ISSUED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z t� <br /> CONDITIONS OF <br /> .PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <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 /> 5. PONDS,RIVER UNLESS SPECIFICALLY PERMITTED. <br /> a <br /> va0 ,,, o� ; <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my 9 <br /> M <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m ` C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- ; L7 p <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. m ' <br /> m i <br /> SIGN HERE CD ': <br /> (signature of owner or building contractor) (date) <br /> ---�� <br /> ZONING ADMINISTRATOR <br /> N NbINN(71N <br /> N N O N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />