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O(L t'' 1 <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator IV c c <br /> APPLICATION FOR LAND USE PERMITS _ 4 <br /> a ° d <br /> (,�' t'a u l� - S 3 - 1 FL <br /> OWNER JT. <br /> �� TELEPHONE ^gyp <br /> lir 0 <br /> HOMEADDRESS59/5 Like C.(dr U� LIU t I)K DO/V�L�YI C _ N,m ss7o�% r <br /> 0 <br /> EMERGENCY/FIRE NUMBER &:369 ROAD NAMESL421t° /?,C '76 <br /> LEGAL DESCRIPTION(see tax receipt) I ccs m y 15 Pig Go u L&' 4 <br /> s <br /> N � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION— <br /> 06 <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> N <br /> STRUCTURE/ADDITION USE: O R 2. 6d'f-7 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;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. 0W <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 0 $ <br /> .. < Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn .F n <br /> NORTH(N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m ` l <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. 0 <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. 64Ul <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 2. <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 <br /> ISSUED. o' 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c �f <br /> CONDITIONS OF PERMIT: <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 OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. p - mmRDa�ov <br /> 3 2. 01% % <br /> 6. Cw0 i <br /> No � 3 <br /> Z w '2 : '� � <br /> 7. _y; <br /> e <br /> i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; ZS ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? n <br /> all information contained in this application(including any accompanying schedule)and l 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 <br /> sue a permit. 1 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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> - : <br /> m : <br /> .2SIGN HERE <br /> (sl reof r r building contractor) (date) <br /> ZONING ADMINISTRATOR 40 w w w H w`� <br /> 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />