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Cn C�Z�o <br /> BQrnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) z <br /> APPLICATION FOR LAND USE.PERMITS . _3 ° °SZ� <br /> N r <br /> OWNER P�`'Cj � !' ` ELEPHONE 7/S - <br /> s /l O <br /> s m <br /> 7 �HOME ADDRESS c P1 <br /> EMERGENCY/FIRE NUMBER .S ROAD NAME 444 e <br /> LEGAL DESCRIPTION (see tax receipt)C 3 M S (J a opgs /?3 'd o7 6r 7 4 C5 <br /> U m <br /> c <br /> a <br /> �y o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION � <br /> v <br /> CL <br /> S. <br /> La. cl <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> Q m <br /> STRUCTURE/ADDITION USE: cle <br /> < i <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> MN <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS (NB)AND INDICATE m !? y <br /> NORTH(N). W <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, 0171 <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 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. S. o <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 <br /> ISSUED, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. W �1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SH <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFIy <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 7 T OF T�tl � IVf KES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> � q <br /> 5 <br /> cab; �{� 110 <br /> 6. M 3 CL CD <br /> Q <br /> 7. �C v / P : y �� ' ;U- wn m <br /> I declare that this application (including any accompanying schedule) has been examined b n of my 2 p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the etail an accuracy of m � C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> Q_ m <br /> SIGN HERE U �' ( ' <br /> (signrel owner orbuilding ontractor) (date) <br /> ZONING ADMINISTRATOR _ jk 1 Nh <br /> cnvrtnt»f»cn� <br /> N N Cn N N IT U <br /> [T fT O CII Uf O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />