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6h ( J <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v e) <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> F <br /> OWNER �aJ*EPHONE 260 --73- ,7 a /\/^ . <br /> HOME ADDRESS O <br /> &q lepZ D i°U t 1(S J K �• <br /> EMERGENCY/FIRE NUMBER �(�8� — ROAD NAME De l5 �� ��C • t° � M <br /> LEGAL DESCRIPTION(see tax receipt) a 7 7y0 lu-/c&CEJ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE %�ADDITION� 1 a <br /> 5. <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> rn —a STRUCTURE/ADDITION USE: 7-tl�1Gt1 1�JI`J CQG]P � � [�1✓" - , <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) A <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR it <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _ <br /> a � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 C> <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> S Zp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M ci <br /> NORTH(N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO IM <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 49' Z <br /> STREAM OR RIVER. o <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. E <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 �p <br /> MUST BE SIGNED AND DATED BY THE OWNER. n' o I <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z V <br /> CONDITIONS OF PERMIT: P ' <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 /> ;a � 2, o L <br /> 6. a wn Q m <br /> � =z <br /> Roamz <br /> 7. o <br /> =N: m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my �$c ; p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i m' (;) E i S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i m E '• A <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 application. I agree to pe it county offs als Wiarged with administering county ordinances or other m <br /> authorized person to have access tq the abgRe descA ' any reasonable time for the purpose of inspection. m E E <br /> e : <br /> SIGN HERE <br /> sign Lure o ner buildi g contractor) (date) <br /> ZONING ADMINISTRATOR L • . . • . . H <br /> N NN1NNta a� <br /> N N O N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o c c c c o 0 <br /> 0000000 <br />