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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator - <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N 0 <br /> OWNER1� `/ G I Z� •'�I- TELEPHONE Z,12 /��/— 16 / " O <br /> �^ S <br /> HOME ADDRESS' jL �a / -fcQ C� LA L�[ �'� I�I�►, �j �J y� /� ° <br /> EMERGENCY/FIRE NUMBERS ROAD NAME e <br /> I <br /> S r <br /> LEGAL DESCRIPTION(see tax receipt) ti <br /> , ti 3 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-2V67 GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> 5. <br /> e <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> (� CA <br /> STRUCTURE/ADDITION USE: <br /> Z � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 3 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> m <br /> DIRECTIONS FOR PEAT PLAN DRAWING: (AERIAL OR TOP VIEW) �$ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 4 jo <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). N ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. 6 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS ? S. <br /> MUST BE SIGNED AND DATED BY THE OWNER. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q ° <br /> ISSUED. 2 f � ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o � � <br /> CONDITIONS OF PERMIT: _)C) <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 /> Qte <br /> 6. a'� 9 CInn '*" a <br /> Z : a RQ i <br /> 7. o <br /> M*w: € m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; ZS C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �E '; o. <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize o m <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 E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> CD : <br /> CD : <br /> SIGN HERE <br /> (signature of owner br building contractor) (date) <br /> ZONING ADMINISTRATOR �JI(T� � iWn N64 iR 4 • <br /> en ri NEn <br /> u7 NU1 n1 <br /> N N p p p p . <br /> G <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />