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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> 0 <br /> N <br /> C <br /> OWNER 01i 1/e TELEPHONE — 71xc <br /> O <br /> m <br /> � _ Q !n <br /> HOME ADDRES G / x S �� ��� U O 0 <br /> r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME O <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) —f^ '� c5rot t/U! 15" C <br /> Oa o c <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION v (� <br /> a <br /> 5. <br /> N r^ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 �/` <br /> Cn <br /> m <br /> STRUCTURE/ADDITION USE: /C CQ e Sc ee'61 _ y l,,,416,'� if <br /> (Home/Cabin; 6ommercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> m 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 = <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C1 ooi <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <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 3 <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. 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. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q 0 <br /> ISSUED. <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 <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. W <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 /> OM <br /> m . d , m O m <br /> 6. v m C y " o 3 <br /> Z . N O O 9 =j7. P : e <br /> 1y , m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Lj c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including an accompanyingschedule and 1 further declare that I recognize <br /> PP ( 9 Y ) 9 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 0 <br /> �: <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 gyp` m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> M ; <br /> SIGN HERE <br /> (si a re of owns o u ding contractor) (date) <br /> ZONING ADMINISTRATOR ,cw <br /> �N'K3 <br /> Vl Vl O Vt O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />