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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v-0 o <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 <br /> N <br /> C <br /> OWNER © �tiP�� le.V TELEPHONE (O <br /> ` m <br /> HOMEADDRESS7aNSit <br /> EMERGENCY/FIRE NUMBER 1 I � ROAD NAME hy') kcL <br /> P <br /> LEGAL DESCRIPTION(see tax receipt) a -3 Csm V. a p !27 ) Ul 5 <br /> 0 <br /> y � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING--,X—GARAGE/ACCESSORY STRUCTURE ADDITION cr <br /> 5. <br /> m <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: Aory\(- — <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In 3 p , <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. V�' <br /> MI <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) In Y' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). <br /> 3. SOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m cr� 9 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. ° <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. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. e 1 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS = W <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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. _ r <br /> m nth C M <br /> 3 <br /> 6. v : (coo 703 <br /> Z : <br /> (coo 70 <br /> : <br /> 7. —co i i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my E C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? n <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize !^ m <br /> 13 <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d <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. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premisits a any reasonable time for the purpose of Inspection. CD <br /> T <br /> m <br /> SIGN HE <br /> (signature f owner or lul Ing contractor) (date) <br /> ZONING ADMINISTRATOR os h w w w w <br /> N NNNN (TN <br /> (n fTOfJ�NOO <br /> O0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 c 0 0 0 0 0 <br />