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oy� C4'p <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. ',n <br /> r —v 1 <br /> N Imp <br /> OWNER <br /> �YLJ?_-jpr6t\)w � TELEPHONEh <br /> � Q39—o369 <br /> d <br /> c c 0 <br /> HOME ADDRESS �►eni e�o�K J���� Sy <br /> EMERGENCY/FIRE NUMBER ROAD NAME�p t;q �AA;,W � <br /> IV <br /> LEGAL DESCRIPTION(see tax receipt) So e A4c..W- T(Jk r`� "P; 1 (D '1 <br /> S <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> c <br /> Q <br /> S. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> C., <br /> STRUCTURE/ADDITION USE:`r CnI> en%n.i <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> x w <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O CD <br /> n n <br /> Z! Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m ` 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- O <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 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEr i 1 <br /> ISSUED. � QW� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: ; O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. v <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 /> ;a -0 0 r 0 k 0 -0 <br /> 6. 3 a m <br /> a <br /> a ' CH '" c 3 <br /> = y'0 0 20m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ; 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 m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 ree to permit county officials charged with administering county ordinances or other ; m E <br /> authorized person to have ac ess Nthe above described premises at any reasonable the purpose of inspection. m <br /> SIGN HERE <br /> ( Ign ure owner or b g contractor) (date) <br /> ZONING ADMINI T ; I <br /> to <br /> wwwwfn <br /> " "CAW "mfr1m01 <br /> Vt 9"O Q1 V1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIR D 0 0 0 0 0 <br /> 0000000 <br />