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U0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ir 0 <br /> OWNERink.a Vr ' � �` TELEPHONE <br /> HOME ADDRESS,,A//k/ - '�r a�i & __Z 7 o <br /> 1 , II II .. <br /> EMERGENCY/FIRE NUMBER a a ROAD NAME t11© +in oy 3-5 r. . <br /> r 7 <br /> LEGAL DESCRIPTION(see tax receipt) Lrc_a4d t n GeU ' j Se-r— 2 7 — �g— 17 <br /> c .8D 'f`k'u-S to y o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION n <br /> S. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 "5 <br /> d� w C <br /> 3 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; c.) v U) _ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3Uj <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 00 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 ii <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 e 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M 3 <br /> P <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. ° <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS ti <br /> MUST BE SIGNED AND DATED BY THE OWNER. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. = <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 5.) <br /> CONDITIONS OF PERMIT: 1 Li <br /> I <br /> t. 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 WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. ;a - mro O o -0 <br /> � o. <br /> m <br /> 6. nl C N m O <br /> N O : IO <br /> 7. 0 m N ;a: rn <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C'rIS <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ii E ; c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD ; 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 p m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. _n <br /> m : <br /> m : <br /> SIGN HERE <br /> n ture ner ildl contractor) ate) <br /> w <br /> ZONING ADMINISTRATOR <br /> H 40 to K) K)ch <br /> N r) L" <br /> Vt OiOtn pl00 <br /> O0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED O O O o O O 0 <br />