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V' ' C" <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> N 0 <br /> C <br /> OWNERTELEPHONE a <br /> � enr,, s C tom ssl+ev � � >-�a �=� yc� o <br /> d <br /> HOME ADDRESS /V g 9 5 �c( te /1 6 S „ ear l a I 1 y lfl�F e4 Sf 1. <br /> r a; <br /> 0 <br /> EMERGENCY/FIRE NUMBER `,� 7 D ROAD NAME <br /> y � <br /> LEGAL DESCRIPTION(see tax receipt) �vTI B 3 I srAd eW r es c� y <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: LIy 1� 1 oo,4r'> � 6r�1 a� 6f V <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR n T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) / 6t 935' 7s W `d9d eF I <br /> 6S :J I T G <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. &rrd-_0iW ice/ m 0 a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO In o <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. <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. =Ln <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o v <br /> CONDITIONS OF PERMIT: (1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 <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 /> ;aML <br /> 6. � 3 a c E 3_ <br /> Z ! w o _� 1 <br /> 7. ? ca i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS g S+ C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? CL <br /> W <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> M <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> m <br /> SIGN HERE <br /> Ign roof o or building contractor) y �i die <br /> rf - - -- <br /> ZONING ADMINISTRATOR <br /> lA H H 40 fw <br /> JIM ,�� rj on c) <br /> TOWNSHIP PERMITS MAY BE REQUIRE `, 6 'i' 000000 <br /> 0 <br />