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Burnett County 7410 Co. Rd. K, No. 1102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O <br /> OWNER ��� I TELEPHONE (?1 SJ ,Z(o�— <br /> HOME ADDRESS (D ,5 C <br /> EMERGENCY/FIRE NUMBER { ROAD NAME (,). (,oylripr j L c 4C g2l <br /> LEGAL DESCRIPTION(see tax receipt) (D <br /> Nn <br /> 0 <br /> y � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION <br /> Njj <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> m <br /> STRUCTURE/ADDITION USE: B <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> 1 <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR n 33_ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> a7 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ;bm <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). CO) O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> v <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- Q> <br /> INGS, ROADS, LAKE, LOT LINES. :E O <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q ° <br /> (QV�V <br /> ISSUED, 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o O <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I 1 <br /> ISSUANCE. r <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 0 <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 M. W r p D E m <br /> OLD. 3 a C6�1 C M. 3 <br /> • CD yN <br /> . o _ <br /> Z N ,O "I <br /> 7. P a7 <br /> tea : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o B <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m CD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> m : <br /> Lt C� w <br /> SIGN HERE � ,� <br /> a of ow or Ilding contractor) (date) <br /> 0: <br /> ZONING ADMINISTRATOR <br /> cnwwO O to M <br /> N N N u <br /> (Ji (T 0 O 0 O <br /> O <br /> O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED O o O 0 0 <br />