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oflcofTl <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator a o 0 <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> o <br /> OWNER �i�<l7,PELLO ��yL TELEPHONE <br /> f <br /> HOME ADDRESS �a� A�•�+ �L Tp r/ , ^LA���L/!L�r , /,(/ s�O v y 00 <br /> EMERGENCY/FIRE NUMBER <br /> ROA <br /> i 6 <br /> LEGAL DESCRIPTION(see tax receipt) o—r _ C <br /> 1.3 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION Cr <br /> o <br /> c <br /> Cr <br /> S. <br /> S.N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT ^^SUBDIVISION o d <br /> STRUCTURE/ADDITION USE: <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 c <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(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, c <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. �9 <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. ro c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 3 0 C> <br /> ISSUED. (/} <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z I <br /> CONDITIONS OF PERMIT: o Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <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 /> z v o r o v m/eGo67 /t'11dri elle (/ rsya- <br /> 6. <br /> , � D C � 3 <br /> N . <br /> 7. Z : !" � �fO1 <br /> O <br /> =yxE m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p p <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy ofm E i C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 'mm <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 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 hay#access to the aba de bed premises at any reasonable time for the purpose of inspection. m <br /> N <br /> SIGN HERE '— <br /> si tore of owe II tractor) i <br /> ZONING AD R I i' i <br /> 14 <br /> fRNNN lA <br /> O 0 0 0 0 0 <br /> WN$HIP PERMITS MAY BE REQUIRED �] 'Gj ' O 0 0 0 0 0 <br />