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C 0� 1 <br /> Burnett County 7410 Co. Rd. K, No. 1102, Siren,W154872 Office of Zoning Administrator -a o 0 <br /> APPLICATION FOR LAND USE PERMITS . < <br /> r <br /> N .. <br /> P tf'\ 1 I! C <br /> OWNER S�l,h J �(�wltc �)� E}S ter telc�� TELEPHONE 8ql _ �2 CACI _ 0_�11 U o (�, <br /> 4 T lS /Y•� O <br /> HOME ADDRESS 1s7 l,Jth�e� .gyti. +< ("T` P(b�e�- 1 � (OC30 s� 9 <br /> �p� o � <br /> EMERGENCY/FIRE NUMBER g`� ROAD NAME C�(t �t�l I ~ <br /> LEGAL DESCRIPTION(see tax receipt) G0 <br /> a CS ✓, Q. 15�, �' - a'� yr,-1 - <br /> N � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE-4—ADDITIONv <br /> CL <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 `V"{1�,_ <br /> VJ <br /> STRUCTURE/ADDITION USE: 2�Xe2��rzchart w�/�X4 ���C S4vrc� oa. Eosk s'j� 6; 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 3 �_ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. = a <br /> 711 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m g . 'p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y c <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. <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. I 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS n) <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 7� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q i i) <br /> ISSUED. �) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: _` >S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT l J <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 /> PON S, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. B be, a+ leo_& 10 :7t 4n3e) 14 at.,, v*+*lis <br /> ;a v 0 r 0 0 9 <br /> m �. d �6. aim <br /> a m <br /> co, . <br /> 7. Z : m m� =j <br /> o : <br /> ly : m <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 aEr <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- 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 ave access a above described premises at any reasonable gne for the purpose of inspection. T <br /> SIGN HERE OR <br /> I ature f rorbuildin9 contractor) ato wE fE nwE wE <br /> fnw 4i <br /> nZONING ADMINISTRAT <br /> I N NfI� NNfJiN <br /> N f11 O UI toOO <br /> TOWNSHIP PERMITS MAY BE REQUIRE L� i <br />