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C�z ev� <br /> Burnet County 7410 Co. Rd. K, No. 102, Siren,WI 64872 Office of Zoning Administrator _ o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> N � <br /> to <br /> C <br /> (D <br /> OWNER �(� TELEP ONE 2/� 6 �17/ 0. <br /> v � 6 <br /> m <br /> HOME ADDRESS ���, )Z 0 <br /> EMERGENCY/FIRE NUMBER Z ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) (�����n i <br /> FC ?s r CD <br /> o <br /> TYPE OF PERMIT(S) DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION v <br /> a <br /> y <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> lu <br /> N <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) a <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) a <br /> n � Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m W � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). Ch o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, t Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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. W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <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. <br /> a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a S <br /> ISSUED. w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: R <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C� <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 /> ;U � 0 0 'V <br /> 6. T.K CL C in m o a <br /> N I9 R : :3Z -4 <br /> �� <br /> 7. o <br /> — m m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is y O <br /> sue a permit. I further accept all liability which ma a result of the County of Burnett relying on this information I am m' <br /> providing in this applicat' n. 1 agree to permit unty officials charged with administering county ordinances or other rn ' <br /> authorized person to ha a access to the abo described premises at any reasonable time for thq purpose of inspection. _n <br /> rn <br /> m <br /> SIGN HERE <br /> (sig'na�e_of own r r building contractor) (date) <br /> ZONING ADMINISTRATOR �flliG14J <br /> v+ viF»cnwcn <br /> N NU1N P <br /> cn cnocn Ln u+ O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o c o o c o 0 <br /> 0000000 <br />