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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning A md- inistrator `Y- 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> CD <br /> _ a LT_ <br /> OWNER c— TELEPHONE <br /> it <br /> m <br /> HOME ADDRESS L^ \\� ",� (�_L u <br /> - r � <br /> EMERGENCY/FIRE NUMBER — (d'1 ROAD NAME, ;�I. <br /> LEGAL DESCRIPTION (see tax receipt) U 1 y <br /> m <br /> n <br /> a <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION rr --� <br /> S.N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> N <br /> L <br /> IL1 7 <br /> STRUCTURE/ADDITION USE: - L 1 4 / L I fir <br /> (Home/Cabin; Commercial Business; Bedr om; Deck;etc.) <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 _ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> T � Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m n <br /> NORTH(N). W <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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. CS N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS I 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. U2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q 0 n� <br /> ISSUED. = y J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Jzl <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 t=J <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 /> m <br /> 3a11 <br /> 6. mcH <br /> Z : m <br /> 7. M <br /> q <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 c C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of O I'm c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize M <br /> `° m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y O <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 E m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> m <br /> SIGN HERE <br /> (signator of caner r ' i contractor) (d t <br /> ZONING ADMINISTRATOR <br /> w w w w 1��N N P N N �O V7 O 0 0 0 0 TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />