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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o a <br /> APPLICATION FOR LAND USE PERMITS <br /> w O <br /> OWNER � �"� �� e%YJ �✓ ' TELEPHONE <br /> v <br /> m <br /> HOME ADDRESS 7� / / N <br /> EMERGENCY/FIRE NUMBER ///�} ROAD NAME <br /> LEGAL DESCRIPTION(see50 <br /> tax receipt)QM�d t�goopm ',T LFif7 �� /�/f//''�6� to <br /> zav - y 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE 1 ADDITION C <br /> cr <br /> n <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 L <br /> � , <br /> STRUCTURE/ADDITION USE: � i <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 2 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> X <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> ?� a Z <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). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rn 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. P <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. (� 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ell <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 BE5 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: DO <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 0 <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. X/ J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. V" <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. pp <br /> 6. n 'F 9 % <br /> r_0 0,91C <br /> 7. o i a � <br /> =y: <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS c `• '• p <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of n ' C <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize 0 ii ' ;a <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have a5gess tot the above described p emis at any reasonable time for the purpose of inspection. <br /> .� <br /> w <br /> SIGN HERE <br /> (signature nor or building contractor) (date) <br /> ZONING ADMINISTRATOR r) ' <br /> V/ wwwwww� <br /> N N G N N V1 fJ� <br /> NOfJ� N 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br /> 0000000 <br /> &Do sear 6 7 <br />