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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator � p <br /> APPLICATION FOR LAND USE PERMITS <br /> w <br /> OWNER 12 r 1- T ��1/7> �L� „/'TELEPHONE <br /> � 7 j <br /> HOME ADDRESS / M O <br /> �V <br /> d T`ay <br /> EMERGENCY/FIRE NUMBER ROAD NAME '—' I <br /> we <br /> 1 �..r . - <br /> LEGAL DESCRIPTION(see tax receipt) 3A -4 3� C2 <br /> m <br /> Cr.in <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION C -� <br /> C <br /> CT <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 7 l•J <br /> STRUCTURE/ADDITION USE: <br /> C;) LAN <br /> (Home/Cabin;Co ercial Business;Bedroom;Deck;etc.) v 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3. <br /> DIRECTIONS FOR PLOT pi AN pgA ING. (AERIAL OR TOP VIEW) 0 <br /> I <br /> in <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C ` n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO In <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, v <br /> STREAM OR RIVER. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- C <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 3 V <br /> MUST BE SIGNED AND DATED BY THE OWNER. c vj1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFOREA PERMIT CAN BE w <br /> ISSUED. g <br /> 0 <br /> .. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z d <br /> CONDITIONS OF PERMIT: o n ` <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <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 /> 5. PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. � � dd oL <br /> a <br /> 3Q � m <br /> a St w c <br /> Z <br /> 7. w C o ; 1 <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cq m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ii m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- L� 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. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE `2 J <br /> (signature of owner or building contractor) — (date) <br /> V: <br /> ZONING ADMINISTRATOR I Y1 Jlr1 t i i <br /> hv+urwwu40 <br /> SNi� �oircNi�oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />