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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator v o z <br /> APPLICATION FOR LAND USE PERMITS . <br /> r. r <br /> o <br /> OWNER � IgJ3OA <br /> HOME ADDRESS Ff'LAr..rtc_ Vl/{ , 0 <br /> Q -+ � o � <br /> EMERGENCY/FIRE NUMBER a ' l� p� ROAD NAME 4wT Lc� " ,N��� l <br /> 5)d *73-7 U18W a —3-1— Ig - c>- 0 d►(201\0 <br /> LEGAL DESCRIPTION(see tax receipt) Lv3r 3 LSM U ( � P JOy (�,aJ Ca'E l ) ca <br /> '/ e O <br /> TYPE OF PERMIT(S):DWELLING/BUILDING ` GARAGE/ACCESSORY STRUCTURE ADDITION Q <br /> CL <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> -L USE: F X 448 Lk)/ I��Y CIc� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <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 <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m I, 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. (1 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- U <br /> INGS,ROADS, LAKE, LOT LINES. I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 9 J <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS I S <br /> MUST BE SIGNED AND DATED BY THE OWNER. pp m o u <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE r.J, q 0 <br /> ISSUED. vv T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q O <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 OHWM OF LAKES, '1, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. bW <br /> 5. <br /> Mpp 'amr o�o � <br /> 6. v.� 9 CxO2 � <br /> 7. o a <br /> =V)€ i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 3 g ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of v <br /> CL <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 Burnett Wisconsin in determining whether to is- m t7 <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 acgess to gis above described premises at any reasonable time for the purpose of Inspection. -n <br /> SIGN HERE d O—00 <br /> nature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR m <br /> NHHH4/N� <br /> N N C71 N N CA 51 <br /> fT fTOfT fT00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />