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J <br /> 69 (W)tl <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> - 0 <br /> 0 <br /> APPLICATION FOR LAND USE PERMITS a 4 <br /> r <br /> DO <br /> N <br /> OWNER �le � TELEPHONE3s7�z 2 <br /> Oig <br /> m <br /> O <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAMEjrfpL/�jv f ('V <br /> LEGAL DESCRIPTION(see tax receipt)L / ca <br /> to o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE_X—ADDITION ' <br /> c <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION Q) <br /> i N <br /> STRUCTURE/ADDITION USE: fi'/oO 5 e/le le c:1: CP <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. r <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m o <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 BUILDLQ <br /> - <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. So <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q ° X/ <br /> ISSUED. 2 <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <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 SP IFIL LLY PERMITjT <br /> 5. No ,Ilt,.b a� U A#y_ rl�ttQd <br /> � -0nr oov <br /> D+ <br /> s. �, PIw �� fa 6e ►Ns42241 � �N N = <br /> 7. " "� ' � � <br /> .N; <br /> m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my ; t j c i i i p <br /> 1 n <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m I, <br /> all information contained in this application(including an accompanyingschedule)and I further declare that I recognize a <br /> PP ( 9 Y 9 (D fD € m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y 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 m <br /> providing in this application. I agree to pe it county officials charged with administering county ordinances or other cmc <br /> authorized person to have cess to thealffil described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> CD : <br /> SIGN HERE <br /> Ig ature of ow or r building contractor) (date) <br /> ZONING ADMINISTRATOR w <br /> ahh�HCM <br /> N UI N N V1 U1 <br /> . PPPPPP <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />