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Burnee County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> 11 o <br /> (9� Sl 86 Ali,,Of S <br /> OWNER ��/ C�js1/� S TELEPHONE 386 - 7y9ir m <br /> O <br /> HOME ADDRESS y3/ /f, 910 U P2 �� 4 d/Soh S V01 G 9 <br /> r � <br /> EMERGENCY/FIRE NUMBER a y 3 g ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) .S� <br /> N <br /> o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—,r--ADDITION a <br /> S. <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <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 T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T $ <br /> ?� Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m $ �A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). ° <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, Z <br /> STREAM OR RIVER. 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. <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 /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o C) <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WlTHN 75 FE�jT OFT H OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. �j'���� <br /> 5. y ;a -0 m m okom <br /> 6. <br /> SNic <br /> St co <br /> 7. —Cnr m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best$f my ? ej r : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize W m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m ` 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 m <br /> authorized person to h e access to the above described premises at any reasonable time for the purpose of inspection. T <br /> - : <br /> m : <br /> SIGN HERE <br /> (signatu of owner b I nfrac r (dam <br /> ZONING ADMINISTRATOR \� / fn H H N w N <br /> PiC" pan ci�En <br /> TOWNS IP PERMITS MAY BE REQUIRED <br /> 0000000 <br />