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Burrteett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Admin`istrator� -7 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> N O <br /> OWNERl ` I c <br /> t1 Ltr 1 II QL!yp hJ TELEPHONE <br /> 1 � <br /> HOME ADDRESS �� ��� 5O �o� rv5ow/ 1.A1� .�� `► �S�tY \►� 15 f� Qy� <br /> r m <br /> f� 0 <br /> EMERGENCY/FIRE NUMBER I �Ub�1oJ VtROADNAME ) <br /> 1 ( rt <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 0 <br /> So�E � o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ CCESS Y STRUCTURE ITION 0Q c ' <br /> P� b � Mn�� e. <br /> SANITARY PRIVYFILLING/GRADING CAMJNG UNIT SUBDIVIS10 0 Q <br /> F"t-Ill De+ ���l� V) 7�j <br /> STRUCTURE/ADDITION USE: fir <br /> .I UI �JJc1{I�Lv <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> ' 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 /� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 70 C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) CL <br /> 0 n CD <br /> C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE Q} <br /> NORTH(N). W c o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS o <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o ' <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> N p <br /> ISSUED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ` <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 /> z � 0r U01 <br /> 6. 3!7. o € !^ ° � <br /> _rn <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> 3g C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of ? o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 0 m <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. 1 agree to permit county officials charged with administering county ordinances or other E m <br /> authorized person to have acc ss to the escribed premises at any reasonable time for the purpose of Inspection. .n <br /> m <br /> SIGN HERE <br /> (sig lure of ow er or buil ..contrractork (date <br /> ZONING ADMINISTRATOR %Y1 j <br /> CHH <br /> N N Vt N N <br /> Ut V1 O N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED i;o <br />