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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -it c o <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> n <br /> OWNER Q OKy tTELEPHONE <br /> / � <br /> Sy2o�, � •z 6-7 <br /> HOME ADDRESS O <br /> 1 � o <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> Lk. � v„ <br /> LEGAL DESCRIPTION(see tax receipt) ikO c 4,54 04t0d <br /> 0 <br /> y � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAG CCESSORY STRUCTURE DDITION ii <br /> CL <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION c <br /> STRUCTURE/ADDITION USE: 61. <br /> 1 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> In 3• <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> .'0 01 <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> T Z <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 <br /> NORTH(N). y c <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, Z <br /> STREAM OR RIVER. P <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1° °o ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE rn o <br /> 4 -+ <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 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 /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> Av or�- 0go1vn <br /> n�3 <br /> 6. 2 n W o z <br /> • co w . <br /> 0 am <br /> o : <br /> =c'. . <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C m; M <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all Information contained In this application(including any accompanying schedule)and I further declare that 1 recognize CL <br /> m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 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 E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> m <br /> SIGN HERE Ur <br /> (signature <br /> eof oviner <br /> 'oorr b ding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N f T N N t J 1 N <br /> Vt N OfJ1 NOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 90000000 <br />