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e'n C'�5)xvp <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 64872 Office of Zoning Administrator -0 c1 Z <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> r <br /> w o <br /> N <br /> OWNER TELEPHONE <br /> () <br /> HOME ADDRESS �� Sj �?3S �� !- / � a� O <br /> C- 5301193 �F <br /> EMERGENCY/FIRE NUMBER / � ROAD NAME p / <br /> Pin el Rom�{ <br /> LEGAL DESCRIPTION(see tax receipt) p ���fy s�� C� <br /> c 7-,:?711/-e 8 Z y <br /> -�,G <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_�GARAGE/ACCESSORY STRUCTURE- cr <br /> CL <br /> 5: <br /> SANITARY PRIVY FILLING/GRADING CAMPING U T SUBDIVISION t°. o <br /> � � ) ffars� <br /> STRUCTURE/ADDITION USE: � W ��� T <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z 1 <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. <br /> DIRECTIONS FOR PLOT PL6N DRAWING. (AERIAL OR TOP VIEW) O m <br /> T 4 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. v Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m f <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 \ 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, I C�Z <br /> STREAM OR RIVER. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES Tp <br /> O 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 0 W <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> co <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFOREA PERMIT CAN BE 0 <br /> N p <br /> ISSUED. g -.. � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c` ' 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � Q <br /> ISSUANCE. 2P .0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY J 00 <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 /> X M n 1- <br /> 6. <br /> 6. ID ID CML <br /> � <br /> a <br /> 7. �.. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zg c. m <br /> Or . <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C ` C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o o m <br /> that this Information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is. G� 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ; m <br /> m : <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m i <br /> CD : <br /> SIGN HERE <br /> gnature of owner or building contractor) (data) <br /> ZONING ADMINISTRATOR <br /> vfA <br /> 40 <br /> ,cNi+Zip,In o <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br /> uoc <br />