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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v o <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> r <br /> w o <br /> • w <br /> C <br /> OWNER '("I{dryt s e�MAR�EW E G , P1 h62` TELEPHONE( 7l 5 J 635 G01 2, v <br /> HOME ADDRESS (8►2. 5/ l�F/5 RD• S,x��Lf, Y `�-�--� ADI 0 <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME SyK6C, <br /> SG 10.32 444/455121 - 510 T40 Rlq- ACRE5- 1• I r �75_ <br /> LEGAL DESCRIPTION(see tax receipt) 2^�I4'IQ '1 d O t'�4ZC10 0 <br /> rO V <br /> y � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION n <br /> 5. <br /> g. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION Cn C <br /> m <br /> STRUCTURE/ADDITION USE: GAgi N <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) � <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR -n 3 ' <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) kob <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 n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m P <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- <br /> INGS,ROADS,LAKE, LOT LINES. 06 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N I <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. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a a O <br /> ISSUED. j n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o v ' 1 <br /> CONDITIONS OF PERMIT: a) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 001 <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 /> � m <br /> * : COo� <br /> 6. • .o w <br /> litw <br /> 7. Z <br /> CA 7' <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c i i i c <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize m m : m <br /> that this Information I am providing will be relied upon by the County of Bumett Wisconsin in determining whether to is- <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' i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ` E a E <br /> authorized person to hjvif access to the above d ribed premises at any reasonable time fo a purpose of inspection. <br /> SIGN HERE q <br /> (sl ature f owner Ing contractor) (date) <br /> ZONING ADMINISTRATORH <br /> — 4 <br /> MEe MMfA (A <br /> Nm1 N NNO <br /> - U V•O (11(IIOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />