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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 64872 Office of Zoning Administrator V I sk oC <br /> APPLICATION FOR LAND USE PERMITS a 4 <br /> r <br /> Ld <br /> / I /_/ TELEPHONE <br /> OWNER " TT <br /> IF 0 <br /> HOME ADDRESS ONO NO 6/e rL1V f �C�J,4`5 f ff/`4 r Rl L'!P` '�-y/[ <br /> r - I'� 44J` <br /> v <br /> Jr <br /> EMERGENCY/FIRE NUMBER I (Y j I ROAD NAME 0 CI <br /> LEGAL DESCRIPTION see tax receipt) ( y J <br /> S oV) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-X—GARAGE/ACCESSORY STRUCTURE ADDITION Q <br /> a <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> 0) <br /> UBDIVISION <br /> 0 Q, <br /> - <br /> STRUCTURE/ADDITION USE: g <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ja c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn 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, <br /> STREAM OR RIVER. o <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 2. liQ <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o �. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q 0 <br /> ISSUED. S <br /> ( � 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. zo <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 WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> ;a - mm a 0 .0 <br /> 6. <br /> 3 a It ;M0� vCm '" oSZ <br /> � (a i �m <br /> V); i C <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my tic <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize E E <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- y M <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. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to hav access to the above de ribed premises at any reasonable ti eforthem <br /> SIGN HERE <br /> ( n re of ow o building c tor) '- ��(a e) <br /> ZONING ADMINISTRATOR 3 H <br /> NNNNNNV• <br /> UOUQi OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 <br /> 000000 <br />