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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator a o O <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> w r <br /> � w � <br /> C <br /> OWNER <br /> TELEPHONE <br /> �s- 3a�i- 5iQ�9 d <br /> HOME ADDRESS ,�8� `� �j �R�� � � 5Lklt�72— <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) GL LA 19 <br /> 1 Lo rn <br /> iP, <br /> 0 <br /> e <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION v <br /> n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT <br /> SUBDIVISION- <br /> ca <br /> SUBDIVISION <br /> y <br /> STRUCTURE/ADDITION USE: Ce? p,r0E7— <br /> (Home/Cabin; <br /> Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c& <br /> 7. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. S <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m .. n <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m c <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. 0 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q �— <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ' <br /> CONDITIONS OF PERMIT: 1 <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 /> XTmr- v vv <br /> 6. .4 <br /> 3o 5,m70 <br /> o' <br /> a � CI"a w � o <br /> 7. oZ ; aie ° m <br /> � ? 1 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of a <br /> all information contained In this application(including any accompanying schedule)and 1 further declare that I recognize o w : ' MM <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- O <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 in this application. I agree to permit county officials charged with administering county ordinances or other E w E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T S <br /> n m : <br /> SIGN HERE <br /> 1C C AA, ,I,,2 <br /> (signature of er or building contractor) (date) <br /> ZONING ADMINISTRATOR I�� <br /> ah�H�w0 <br /> N NitNNU Vt <br /> iT w O D U O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />