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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator G) o <br /> APPLICATION FOR LAND USE PERMITS 6 <br /> r a <br /> c <br /> OWNER n Q j) TELEPHONE <br /> nlpQ <br /> HOME ADDRESS � ��� T T ^ ��� °`� t-&r <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) r� Wm \/ L�o�' ^ �—�"- � <br /> r/r 7 <br /> ADDITION or <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGEIACCESSORY STRUCTURE w <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION m <br /> berk <br /> aL(' g P� <br /> STRUCTURE/ADDITION USE: u <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. X <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) In <br /> In o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m g <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). to C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, c <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. N \ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 2 c <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ° <br /> 1 <br /> ISSUED. <br /> 10 ) <br /> Z � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: (`l <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTnNG OF TREES AND VEGETATION IS <br /> RESTRICTED <br /> 3. NO GRADI G OR SHORELAND ALTERATIONS ARE ALLOWEDNLESS S EC F CALLRY LINE. <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OH <br /> WM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. II A <br /> R <br /> coo O'BAC <br /> 6. + : y w o : =M1 <br /> Z <br /> 7. =o' m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best c o � ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ; o, ; ' ; m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i : i t7 <br /> Pon by the County of Burnett Wisconsin in determining whether to la- <br /> that this information I am providing will be relied u <br /> m ; <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 ac as t the above described premises at any reasonable time for the purpose of Inspection. - , <br /> SIGN HER (date) <br /> (signature of owner or building contractor) <br /> �, wwwwww� <br /> ZONING ADMINISTRATOR N N o� N N N v, <br /> a, u,oincaoo <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />