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Burnett Cpunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator $ o C o <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> r <br /> ise- g <br /> OWNER , �Y.e TELEPHONE 6j— 3 <br /> rl oo <br /> j/ ���3 ©Je <br /> I 'Dr. s . <br /> HOME ADDRESS /796 lj sf I00 Y1. 9 <br /> r m <br /> Co s aY VA. <br /> EMERGENCY/FIRE NUMBER 7 93ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) �/�L w-Lekxsku <br /> w <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE DDITION Cr <br /> n <br /> 5. <br /> w <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> — <br /> 0) <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; ComrVercial Business;Bedroom;Deck;etc.) i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. In <br /> �A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE In O <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO in a <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, _ <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q °, <br /> ISSUED. n „ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c U\1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <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 /> p 'Unr oa <br /> 0': i in <br /> P 2i <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my E a g E ? C <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <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- <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 E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E m f E <br /> authorized person to have access to the abo a describ9d premises at any reasonable time for the purpose of inspection. <br /> a <br /> a <br /> SIGN HERE 3� ~ <br /> (ala reo W9- a buildingg cSn r) (date) <br /> ZONING ADMINISTRATOR ` ) 1(Yl t" I�O"(ZI�A-�(1 . . . . . <br /> faNNMlMMH <br /> N N N N N N <br /> N O NfT00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />