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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator a o° Y o <br /> APPLICATION FOR LAND USE PERMITS <br /> a O <br /> ur <br /> N r� c <br /> OWNER ,koQeY-'l' Lie i�l�K%e � l b���' �7�.� o ;e <br /> TELEPHONE <br /> C � " <br /> HOME ADDRESS �2 ] OQg Ct7uyifyg , .J o ner/ y = J`tCXI� <br /> EMERGENCY/FIRE NUMBER 700C ROAD NAME CT{� <br /> LEGAL DESCRIPTION(see tax receipt)5Ja S rmi <br /> Cn <br /> o <br /> W o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION n <br /> 5. <br /> LAW <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> CA O <br /> STRUCTURE/ADDITION USE: d ZL <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR _n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. k(A) <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> T a <br /> 2! O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0: b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE y n <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m �p <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. 0 <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. N SU <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. I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ° W <br /> ISSUED. p� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P I <br /> CONDITIONS OF PERMIT: p <br /> I h <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT T <br /> ISSUANCE. CN <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. or-119, Mc <br /> .� 3 CL M <br /> 6.7. ' € y€ <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my iGf g ? 10 <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of A <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognize 'a : i m <br /> m <br /> that this information 1 am providing will be relied upon by the County of Bumett 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 E <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 /> A m . <br /> SIGN HERE n` <br /> (signature of owner r b ing contractor) (date) r9�jh: <br /> ZONING ADMINISTRATOR w <br /> N NIAMHM� <br /> N Nnp NN VI <br /> V• N47N O <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />