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Burnett.County 7410 Co. Rd. K, No. 102, Siren,WI 64872 Office of Zoning Administrator 'U CD o <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> r <br /> y O 90v <br /> C <br /> OWNER TELEPHONE <br /> HOME ADDRESS g--6 A.j <br /> EMERGENCY/FIRE NUMBER f,�R�C5�/7 ROAD NAME Q h7 <br /> 7� <br /> 74ctres .2�oo - •Ho -/7- 13-000afto — y J <br /> LEGAL DESCRIPTION(see tax receipt) �� ��A.3 1.2ja � ��31 � -� 1.3 ,�lRi�w �' <br /> r. <br /> �y o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> U1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Cn <br /> - <br /> I'" <br /> USE: <br /> (Home/Cabi ; Commercial Business; Bedroom; Deck;etc.) <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> n <br /> 2 o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y o <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 AND MEASUREMENT TO WETLAND AREAS. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a o <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT X� <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 SPECTICALLY <br /> PERMITTED. 4 d <br /> 4. , <br /> AttOWEE)1.1 <br /> 5. :E 111 <br /> 6. <br /> � vc�r onDov <br /> 'O ' N C H N O <br /> UI o7. : 0 <br /> V M <br /> — a ? m <br /> 1 declare that this application (including any accompanying schedule) has been exa "by mea to the e t of my L7 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am respo f etail an uracy of as <br /> all information contained in this application(including an accompanyingschedule a`n�i,71 r t eco nize . m <br /> PP ( 9 Y 1 a� 9 m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin m termm g whether to is.. y 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 <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. -n <br /> M : <br /> m <br /> SIGN HERE <br /> (signature of owner or buildin contractor) (date) Q ' <br /> ZONING ADMINISTRATOR /7) C�J ' <br /> Fn Fn w cn Fn v+� <br /> k 043; Ul ON ro OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED % o o O O G C O <br /> \...� o 000000 <br />