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v c / <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator a G)Z <br /> APPLICATION FOR LAND USE PERMITS . ° <br /> ^� r <br /> ff {� /q o <br /> OWNER G L�C, Ih S l J(1�CSM 2 ta✓ TELEPHONE s'_.L S�– 6 L / <br /> m <br /> HOME ADDRESS D I yYI l"� J��. <br /> EMERGENCY/FIRE NUMBER ROAD NAME 1 I 1 <br /> LEGAL DESCRIPTION(see tax receipt) 6VT � —(� co <br /> 0 <br /> e <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION Cr <br /> a <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> l / co <br /> STRUCTURE/ADDITION USE: E tJ G.tii i'.S r 19 X 'O a <br /> (Home/Cabin; Co mercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O <br /> .1a w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <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 <br /> NORTH(N). C v 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. c <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. I <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. o <br /> 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 f <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ICS <br /> II 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 /> tpM . 0r, poo -V <br /> 6. nam <br /> cIn w `" o r <br /> 7. o a0 ?� <br /> _m? A <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m m <br /> PP (� 9 Y 1 Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m `� <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i W O <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- as <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person tq have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> m : <br /> SIGN HERE <br /> gn re of or building contractor) (date) <br /> ZONING ADMINISTRATOR w <br /> NHh�H� <br /> N N <br /> 00 0 <br /> p <br /> N001N01N 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> O 0 0 0 6 0 0 <br />