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nq Gay;rf. <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° c <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER <br /> TAMES + CARDS. PACK TELEPHONE <br /> HOME ADDRESSvVI�' E \ V <br /> EMERGENCY/FIRE NUMBER O?8y'�-t3 ROAD NAME KILKARE <br /> LEGAL DESCRIPTION (see tax receipt) 55C , 7 . T',qO /X 14 U.) ME S,_: <br /> y o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—_X.ADDITION c <br /> \ n <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> ~ m <br /> STRUCTURE/ADDITION USE: S-TU A6r <br /> (Home/Cabin;Commercia usiness; Bedroom; Deck;etc.) X91 i <br /> i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR LV <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> n <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO fill <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <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. <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. m c <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ° <br /> ISSUED. <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. <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. m L o v <br /> t� m <br /> 6. Zn � 3n �c-ate,- .'G <br /> 7. o : <br /> = r € : m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my ii : : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <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- d : C <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m <br /> providing in this application. I agree to permit county officials charged i tkn ordinances or other m E <br /> authorized person to have access to the above described pre =at p I f ose of inspection. n , <br /> �ILL mE <br /> SIGN HERE <br /> �)� _ 8 w . i <br /> (signatu of owner or building contraM r� A '� (date) <br /> ZONING ADMINI TRATOR I (J �( L x . . . . . d,+ <br /> 13URNETT CD N N N N N N <br /> tT to En N fn 0 0 <br /> TOWNSHIP PERMITS MAY BE REpg�(fl�ING o 0 0 0 o ii <br />