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X71 . .; <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis r * o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> o <br /> OWNER TELEPHONE <br /> m <br /> it O <br /> HOMEADDRESS�In RNor = 3A0I r <br /> EMERGENCY/FIRE NUMBER ROAD NAMEnfa(Vj'6LU kd, .. <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) y <br /> y 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION cr <br /> 5. <br /> 4 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT (J SUBBDDIIVISION 0 <br /> ca <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> Ia <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 0 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE r— c <br /> NORTH W 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, c (_, <br /> STREAM OR RIVER. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- p <br /> INGS,ROADS,LAKE,LOT LINES. p <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ^— <br /> ISSUED. g O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o G <br /> CONDITIONS OF PERMIT: 0 <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. _O q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. d <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (� <br /> PERMITTED. (q,T <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5.6. <br /> jj 22 <br /> m n1n 'rF � <br /> 3 <br /> ca: : i M <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my g ; C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of ? n M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- w v <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 a <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> o : <br /> o : <br /> H [ ' <br /> SIGN HERE <br /> (signature of owner or buildin contractor) <br /> ractor) (date) <br /> � � <br /> i <br /> ZONING ADMINISTRATOR ( m 1�iI ` ` ` ` ' <br /> HHMiR iRHN <br /> N Nfr1NN STN <br /> 01 fJl O!r1 N O O <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />