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Burft t'vo;nty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> r <br /> N 0 <br /> c <br /> OWNER A 21 A4 TELEPHONE o v <br /> HOME ADDRESS m �x <br /> r � <br /> Qaba0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> i r <br /> LEGAL DESCRIPTION(see tax receipt) GL Q 'vwn\ y <br /> 1 <br /> m 0 0 <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE-ADDITION- <br /> or <br /> TRUCTURE ADDITION o <br /> Sa <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CA PIN41 3�G U SU�IVISION <br /> V <br /> STRUCTURE/ADDITION USE: <br /> 'e <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. m <br /> x w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 C <br /> ?� Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m N '0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m \ 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> Cr <br /> ISSUED. \ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. j <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 OH <br /> WM OF LAKES, i <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. per�K� <br /> z = tom <br /> 6. .� a w w E <br /> g a o : 3 <br /> 7. o CD i <br /> o) ;a <br /> I declare that this application (including any accompanyingschedule has been examined b me and to the best of m m <br /> 1 Y Y tig E A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize iP io <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- p <br /> sue a permit. I further accept al (lability which may be a result of the County of Burnett relying on this information I am a <br /> providing in this application. I ae to pe ounty' fflcials ch ged with administering county ordinances or other m <br /> authorized ave acce s t the abo de cri premises t any reasonable time for the purpose of inspection. T <br /> - <br /> m <br /> SIGN HE <br /> (sig f gvrner or building c trcctt/or) ate) <br /> ZONING ADMINISTRATOR . • • • • '• w <br /> w w w w w w <br /> N N(T NNNM <br /> u, Vt O Vt ut O O <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />