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Burnett C-)unty 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS 3 7 <br /> w t) �J <br /> OWNER Lades D / rt A,,5 t�LEPHONE <br /> O <br /> HOME ADDRESS ��5 �L ��>ZS tA 57 =TS�+uf 5 3v N <br /> e <br /> EMERGENCY/FIRE NUMBER ROAD NAME 4,," <br /> �(` <br /> LEGAL DESCRIPTION(see tax receipt) L© trltri 6 sv tkti2 n <br /> or <br /> o Cq` <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-. C_GARAGE/ACCESSORY STRUCTURE—ADDITION— n <br /> S. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 —_ <br /> CIO GLI <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business;Bedroom(beck;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. c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> -n �A <br /> t. 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 y c <br /> NORTH(N). m 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TC <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 91 <br /> Z <br /> 0 <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. i <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. to <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. Cr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. S <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 41 +ty <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, V <br /> PONDS, RIVER UNLESS SPECIFI LLY PE MITTED. / <br /> J�� � � ✓✓` <br /> �r5. --U l7 o m <br /> r n _ <br /> 23 <br /> 'a <br /> 6. <br /> o : wOQ <br /> 7. —y tm <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of CIL <br /> ? A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize M <br /> C <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- : m <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 permit county officials charged with administering county ordinances or other m <br /> authorized person to h e access to t above described premises at any reasonable ti inspection. <br /> I � <br /> SIGN HERE <br /> (s at of owner building contractor) `` I �� (date) <br /> I; 3 <br /> ZONING ADMINISTRATo <br /> t N NNNN(n Vi <br /> N fJ� O ND 6 O O <br /> 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED _ <br />