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BurnefXounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER �r-/- m W <br /> C A0 JA Q% !^Io2L k TELEPHONE r^glolw gldp— /(Q(p O g) <br /> HOME ADDRESS PS R36 6 r .RA,&S L(- Rd , "X SA&I- U15 S��J o 1 <br /> r �� <br /> 0 <br /> EMERGENCY/FIRE NUMBER C9 5 83 �O ROAD NAME �,(�. 1_3q s LSC <br /> LEGAL DESCRIPTION(see tax receipt) 0� I a �'QA�ey 1� 3+,J c�/J_ m T <br /> a <br /> Cn o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> orCLN <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: i eC��C• (� �y (P li O <br /> fii <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) < <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWIN (AERIAL OR TOP VIEW) 0 a 0 <br /> G <br /> A Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m O 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. F 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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z , <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I CC3 <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 d <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 /> ; v0� v � vv <br /> nr� m <br /> 6. O N <br /> C' y o J �_ <br /> (0�: :jj m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my "I c p <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of o ': c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- a0i v <br /> sue a permit. 1 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 he above d_qdcrilbed premises at any reasonable time for the purpose of inspection. .n <br /> Y / m <br /> SIGN HERE \ �� <br /> ;gna re o own ullding contractor) (crate) <br /> ZONING ADMINISATOR O. ` . to <br /> 40 4040 CN N P N N <br /> VIP O N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />