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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 07CO <br /> 0 Z <br /> APPLICATION FOR LAND USE PERMITS a < ° <br /> r <br /> w 0 <br /> w <br /> C <br /> OWNER TELEPHONE <br /> v <br /> HOME ADDRESS pat t� / O > � O <br /> A CSG V/d <br /> r w <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> W <br /> -�-- r <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE! DDITION C , <br /> c <br /> Cr <br /> CL <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNITUBDIVISION <br /> In <br /> STRUCTURE/ADDITION USE: ew ee)n r <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) ' -I <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n3. <br /> DIRECTIONS FOR PLOT PLAN DRAWING. (AERIAL OR TOP VIEW) 0 w <br /> O o <br /> m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. M I <br /> Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C 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, <br /> STREAM OR RIVER. Z <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. g c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMITCAN BE a 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c <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 /> v w w <br /> 7. Z � m03C'e = 3 <br /> N (r Q <br /> I declare that this application (including any accompanying schedule) has been examined O M <br /> by me and to the best of my � m <br /> a : <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of i m a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize rn m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- :` 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 m ' <br /> providing m <br /> p gin 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 /> m ? <br /> SIGN HERE H <br /> (si1gnature ow r or building contractor) (date) <br /> ZONING ADMINISTRATOR 1 , <br /> Fn v+«w fn 40 <br /> N N0 N Nkn Ch <br /> 5" NO(T5n OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED0 0 0 0 0 0 0 <br />