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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 3j <br /> N <br /> f <br /> OWNER t ob�-� I'� TELEPHONE Iz Ste^ 3a�f.2 0 <br /> HOME ADDRESS "7��! /S fi�iU�' So I i IIV�Y1eUP04j Y tin. SS`lo V <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER J 3 7 20 ROAD NAMET�bM rr,., ,,,fj .. <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> o <br /> � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION_ y <br /> CL <br /> 5. <br /> N, <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION USE: ib o L101, <br /> c_Pwt.,l-tl�. E-A---f t�(o <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. 0 <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. m23 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). W 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m' o <br /> O Ynl� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c d <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 /> 6. � 3n 3Ca ; <br /> 7. o : N �� ;a <br /> = y: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c� ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 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 m <br /> providing in this appl' tion. I agree o permit county officials charged with administering county ordinances or other (D <br /> authorized person to ve acce;;*4oAhqr above described premises at any reasonable time for the purpose of inspection. m <br /> CD : <br /> C1, <br /> SIGN HERE _ 98 <br /> 7nar f ownergr building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> wwwwww� <br /> N NNNN N(T <br /> U1 U1 O Vt V7 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED a o 0 0 0 0 0 <br />