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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 0 <br /> APPLICATION FOR LAND USE PERMITS s <br /> 0 <br /> a ° ti <br /> w <br /> ",/V � Lr Y <br /> ! rOWNETELEPHONE y 3 a <br /> HOME ADDRESS J S P0,0 N rr `C// s-41Po O <br /> EMERGENCY/FIRE NUMBER ROAD NAME S yj<f J � <br /> ,[.©Ts /R- /y o<' Coil. I-or I <br /> LEGAL DESCRIPTION(see tax receipt) S E-A=T /O S eo r r rawA,1 r11 yo C <br /> o <br /> �o 3 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE-ADDITION-0c C C <br /> Cr <br /> S. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 O <br /> (a <br /> STRUCTURE/ADDITION USE: F!]C C k 44.5 7�tL &X1 <br /> fir <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Q j tol i (��a� 9� 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) ' t 0r.�6— C c <br /> T <br /> U JJ T I <br /> — Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. J 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 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rn 0 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEq 0 ) <br /> ISSUED. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <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 /> M -0 r, pR popt0 -v <br /> 6. 3 ntO °iFa m <br /> 'A 'd 'E <br /> 7. Z i °^ N Q <br /> o : <br /> ca m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; c : p <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i E m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- 0 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this I am <br /> providing in this application. I agree to permit county officials charged with a corm y�ohlfrle �r ther F m <br /> authorized person to have access to the above described premises at any reaso fiortIj_": 4rpose9fJnspe tion. <br /> SIGN HERE t' <br /> Is, a& 001bwner or bu ing contractor) .j I ) <br /> , <br /> ZONING ADMINISTRATOR <br /> M fA fA fA fA fA�+ <br /> �N <br /> Pi CA N NM Cm <br /> (n O P 9"P9 <br /> TOWNSHIP PERMITS MAY BE REQUI 0 0 CD 00 0 0 <br /> , <br />