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Carr , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator � 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> w C <br /> OWNER TELEPHONE c <br /> HOME ADDRESS 0- &nx )o I �L_'))flb(jrV4 0j= ` 7 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME M W <br /> LEGAL DESCRIPTION(see tax receipt) y S I <br /> e <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION— <br /> CL <br /> S. <br /> o' <br /> SANITARY PRIVY FILLING/GR}A�DING 1 / CAMPING UNIT Q JS�UBDIVISION fe ^f <br /> STRUCTURE/ADDITION USE: � I l �/ . )� qs— /q IIU^ <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) �/ ) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR C 3 1 n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. V <br /> W <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) T � <br /> ?I Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rNr1 -' 3 <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 <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 a S <br /> ISSUED. 2 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: _Q } <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT l <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. 9 <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. 2 <br /> 9 ; <br /> Q:6. v Com 0 E r. <br /> ° <br /> 7. Zi e' m � =� 1 <br /> o <br /> y: : ' rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c IS <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of E S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m M <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m 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 m E <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other m i <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> SIGN HERE <br /> (signatures of <br /> owner or b jllding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N NNNNN,(T <br /> ut N O ut ut O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />