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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54720&of Zoning Administrator V/ <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> OWNER TELEPHONE �I �✓pGP� a <br /> HOME ADDRESS 11117 <br /> ff ✓7 ' m <br /> EMERGENCY/FIRE NUMBER ` 0ROAD NAME/J/j <br /> LEGAL DESCRIPTION(see tax receipt) r� <br /> TYPE OF PERMIT(S):DWELLINGBUILDINGGARAGE/ACCESSORY STRUCTURE------ADDITIONCn <br /> o <br /> g <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o' <br /> �iVco <br /> STRUCTURE/ADDITION USE: � <br /> (Home/Cabin;Comm tial Business;Bedroom;Deck;etc.) 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. .n c. O <br /> O <br /> DIRECTIONS FOR Pi OT PLAN DRAWING- (AERIAL OR TOP VIEW) C I. <br /> ro <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(ES)AND ALL NEW BUILDINGS(NB)AND INDICATE m R <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 9 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, p <br /> STREAM OR RIVER. N 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. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> B. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 1 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z w <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 93 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY -p <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, W <br /> 5. PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. � - 0 r- <br /> im <br /> oLa vv <br /> .� B m <br /> 7. v v C a Q <br /> .. <br /> o <br /> I declare that this application (Including any accompanying schedule) has been examined y' <br /> by me and to the best of my <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm ` C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m' ' m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G� <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 permit county officials charged with administering county ordinances or other m ' <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> m E <br /> e : <br /> SIGN HERE <br /> 01 <br /> (sign re of owner ildin trac r) ( to <br /> ZONING ADMINISTRATOR �a <br /> NHM(ANWU+ <br /> N N V7NNNN <br /> k5cs <br /> TOWNS IP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />