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ll <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator ' <br /> -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS I. 4 <br /> r <br /> 0 <br /> Cv 4144h2 - EX3O-?`�-ol/3/3 <br /> OWNER TELEPHONE — / <br /> HOME ADDRESS MJ eef <br /> oa <br /> O <br /> � <br /> EMERGENCY/FIRE NUMBER /�Q �� ROAD NAME .zL 0 <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) P <br /> nyy �e d .Z I w <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION y 0 <br /> v <br /> CL <br /> E. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o' <br /> STRUCTURE/ADDITION USE: f <br /> y <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR v <br /> 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. r . <br /> DIRECTIONS FOR PLOT PLAN DRAWING- 0 C <br /> (AERIAL OR TOP VIEW) <br /> A c <br /> IL <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 I <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <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- o <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o _ <br /> cc <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. <br /> f <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF P RMIT: o <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 /> 5. PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. 3 0 <br /> MX <br /> 7. cw N c 53 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0� <br /> : m <br /> Cr <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of -4 '• m' C <br /> all information contained in this application(including any accompanying schedule)and 1 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- G� p <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this inforrnatlon I am : m <br /> providing in this applica o 1 agree to pe it county officials charged with administering county ordinances or other m ' <br /> E m . <br /> authorized person to c ess to the ve described remises at an reasonabl . . <br /> P Y ose of inspection. m <br /> SIGN HER r 1 q <br /> at re of owner or I Ing contractor) <br /> r �, A 61W ' <br /> ZONING ADMINISTRATOR �'� %�� I <br /> iNMiM""(Am <br /> j.j N Nin NNN(n <br /> TOWNSHIP PERMITS MAY BE REQUIR - 0 0 0 0 0 0 0 <br /> 0000000 <br />