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M-Ap <br /> Burnett C*;inty 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER bfiVfID v EA)6.E( tI TELEPHONE <br /> , CZ �-f -71 Z� p <br /> HOME ADDRESS pZ 9�g(`� j, N / Utr Q4 124, g 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME 100 PUt j L I/- <br /> LEGAL DESCRIPTION(see tax receipt) f-0 --2- CSVv \10 c <br /> Q <br /> N o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION n 0 <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION $ <br /> �o CA <br /> STRUCTURE/ADDITION USE: 4 San ,� 1 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> � w <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) .0 <br /> �+ o Vv Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m g <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N O <br /> _ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. P <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. tj <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS S I <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v � <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. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 20 1 <br /> ISSUANCE. --- <br /> 2. <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 NLESS SPECIFICALLY PERMITTED. <br /> 1�4a F Z*.110 cife <br /> 6. <br /> w o <br /> Z : <br /> 7. <br /> o _y: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c i 10 <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n S <br /> all Information contained in this application(including any accompanying schedule)and 1 further declare that I recognize E m m I ; m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- v <br /> m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett rplying on this information I amm E E <br /> providing in thi a Ilcation. I agraoto permit county officials charged with administering'county ordinaoees-or-other ; o <br /> authorized parsn t9liave acces tot a ova ascribed pre Ises at any reasonable timd'fot the purpose of inspection. m ': <br /> �I h i i <br /> SIGN HERE ` "�P <br /> (signature of o bullon <br /> ZONING ADMINISTRATOR 4 <br /> h <br /> HNH(A iNN� <br /> N NON,fNJi 00 <br /> T NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />