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0)q col t <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o a <br /> APPLICATION FOR LAND USE PERMITS <br /> Y C <br /> /,, // <br /> OWNER s t U P d l[JGn 1`Gt I�Q✓� TELEPHONE6 <br /> / O <br /> HOME ADDRESS C G✓YC l l-I PU 8,)x `i <br /> X � A <br /> r a; <br /> O <br /> EMERGENCY/FIRE NUMBER j0% � ROAD NAME (��1I / f <br /> LEGAL DESCRIPTION(see tax receipt) Se yq r� 5(J yl J %�g� /Cf w lw�i <br /> w 3 <br /> UILDING—A—GARAGE/ACCESSORY STRUCTURE-----ADDITION— <br /> TYPE OF PERMIT(S)6�� 12k <br /> 5. <br /> N, <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> m <br /> STRUCTURE/ADDITION USE: lM Ub IP hnnt ew% [it'S(X p. <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR �i m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Cje 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) ✓�' T ii <br /> T AZO <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C c <br /> NORTH(N). m W <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO a <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. GO 7 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 2. c , <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 Mr ° <br /> ISSUED. {-J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> pMnr vLv � <br /> IP � � awwv _ 70 <br /> 6. W 0 �� 3 <br /> Z <br /> 0 Q i '0 <br /> 7. a) m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best—of <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ( m <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d <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 e <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. - ; <br /> m : <br /> SIGN HERE (date) <br /> .tG7W-- —i�=� <br /> (signs e o owner or building ontractor) -7 <br /> ZONING ADMINISTRATOR d' 3`^`^`^ "Cn <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 00000in <br />