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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> TELEPHONE <br /> OWNER 6'- 7 is <br /> Er <br /> HOME ADDRESS -7 4 1?-1 7�ehnj /,q 0 <br /> C) <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> . .3 ./(. <br /> ipt) <br /> LEGAL DESCRIPTION(see tax rece jr 6. !r 7j <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE__t:_�ADDITION <br /> CL <br /> SANITARY-PRIVY-FILLING/GRADING_CAMPING UNIT-SUBDIVISION <br /> STRUCTURE/ADDITION USE: aC1'V-C%qV'A 6rAyLap <br /> (Home)Cabin; Commercial Builiness; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 <br /> M <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) 0 a <br /> n CL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 13 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 6 <br /> NORTH(N). 0 <br /> 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, Z <br /> STREAM OR RIVER. ls�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 0 <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 /> ISSUED. Uj <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMI <br /> 31 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Go <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 /> ;a -V 0 r,- a 0 -0 <br /> L <br /> 6. ' 3' 5, �%I ;M. <br /> g. g i C <br /> 00 =,Q — <br /> 7. <br /> ca! <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my or i i i <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> u <br /> all information contained in this application(including any accompanying schedule)and I further declare that I <br /> recognize <br /> m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- <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 to <br /> 0 <br /> authorized person to have access to the above described promises at any reasonable U6�0 �tion. -n <br /> SIGN HERE . . . . . . . <br /> ot.�L3 Z — !, I : ; ; : : : <br /> ............ <br /> ontractor) <br /> date . . . . . <br /> ZONING ADMINIST 3 . . . . . 4a <br /> U L 40"�W W"� <br /> " "O "Wmm <br /> TOWNSHIP PERMITS MAY BE REQUIRECCL <br />