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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator � o° 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N w <br /> N <br /> c <br /> OWNER _ TELEPHONE _ _ <br /> IFo <br /> HOME ADDRESS ;2 5 3 <br /> EMERGENCY/FIRE NUMBER ROAD NAME ��7 l c��iix vivo <br /> � � S <br /> LEGAL DESCRIPTION(see tax receipt) a <br /> ✓ - C o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTUREADDITION <br /> CL <br /> N (� <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 3 lx—) <br /> Ch <br /> I <br /> STRUCTURE/ADDITION USE: ZT(1.t'.94 r <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ' T <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 0 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 ,�— <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <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 �, o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 ° <br /> n <br /> ISSUED. P n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 �J <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. �p ,00� o �ov p' a <br /> M <br /> CL SIL <br /> 6. v'� � C$I " 0NE <br /> 0 0 <br /> Z : (Q : <br /> 7. __rn <br /> M <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my Z5 c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a ` , <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 90se <br /> s- O <br /> sue a permit. I further accept all liability which may be a result of the County of u � m <br /> providing in this application. I agree to permit county officials charged with ad i cauthorized person to have access to the above d cribed pr ises at any reason f f inspe o m <br /> m : <br /> 0 <br /> SIGN HERE <br /> W <br /> (si tur w or builcontractor) (date) <br /> BURNETT COUNTY . . . ' <br /> w w 49 <br /> 49ZONING ADMINISTRATOR www <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />