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Comp) <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> co <br /> OWNER ��'�Q� ���� TELEPHONE((CI4:)1 ' 6 Lf a <br /> y WWW <br /> (� � <br /> HOME ADDRESS p1 l/ '9( ( l t ' Y'i /\I o- W o �(�(•i�) <br /> '` .. \\ `� l-0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME CC&' `l�� , <br /> Lot s ,Vo(tam �1 ,�c��Jcs � ,s, � � ocaic i t rr) <br /> LEGAL DESCRIPTION(seetax receipt) I A GOV`I% Lo(- 3 O-f Sec • Z -3•1–i rn <br /> 0 <br /> co o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION CT <br /> C ' (''� <br /> S. C 4 <br /> SANITARY_ _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> -_- y ^ <br /> STRUCTURE/ADDITION USE: e �cJ+ L�[LS R) Z <br /> (Home/Cabin;Commercial Business; Bedroom;De ;etc.) <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 /> O a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T CL <br /> 1 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ID <br /> M <br /> 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M n <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m C002 <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. W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. e 1 y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE g ° <br /> ISSUED. <br /> i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <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. .pq <br /> ie a3F�9 ;M0 <br /> 6.7. c ` C� <br /> CA <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 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize m m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y <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 adminis . .. . <br /> authorized person to have access to the above described premises at any reasonable tie purpbse'41f; T ': <br /> SIGN HERE r ii i <br /> (silVature of ofiffer or building contractor) <br /> i i i <br /> ZONING ADMINISTRATOR 1 QN N N N N N <br /> N N OrNJ� NOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED - c0 0 0 0 0 0 <br /> 0000000 <br /> j4 <br />