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Burnett County 7410 Co. Rd.K, No. 102, Siren,W154872 Office of Zoning Administrator -u <br /> APPLICATION FOR LAND USE PERMITS 4 ° <br /> w r <br /> IS O <br /> w <br /> e <br /> OWNER r—� $ <br /> c' 7 TELEPHONE <br /> m <br /> HOME ADDRESSS <br /> o O <br /> � c 1 m <br /> EMERGENCY/FIRE NUMBER �� ,��7 J ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) VS / <br /> w i i 1 VJ c <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> c C <br /> v <br /> n <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> T = <br /> STRUCTURE/ADDITION USE: m <br /> 119 0 /1 S . r J f IA-, /-),S' //� x <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) / —I <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �t <br /> w <br /> DIRECTIONS FOR PLOT PLAN D AWING (AERIAL OR TOP VIEW) <br /> sn IL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 2 Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE mlir <br /> NORTH(N). C ` 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, ' <br /> STREAM OR RIVER. z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- o <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ry <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. Co <br /> g c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE0 <br /> ISSUED. 5 <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ) <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. t <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �1 <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. 2k� <br /> 6. <br /> a <br /> � Cwwc� � <br /> 7. c who : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my lei2 p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize m E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- p <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 ` m <br /> or other (a <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> � <br /> (D : <br /> SIGN HERE 9 t4otP <br /> (e gnatufe of owner or buil ng contractor) (/date) <br /> ZONING ADMINISTRATOR <br /> i N O 00TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 <br />