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r-'-1 c e,71�' <br /> Bur?tett'County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N 0 V <br /> N fj <br /> OWNER GKE� TELEPHONE � �2n\ <br /> �/ m <br /> HOME ADDRESS g!33 Znd�a�t g/CC. `OT/uPC �S`� a� v 9 <br /> G/DuC /Jlir✓, <br /> EMERGENCY/FIRE NUMBER ROAD NAME m <br /> (o(!S /j'J�d�owv� RcQ /h��ow�r lZc� <br /> i <br /> LEGAL DESCRIPTION(see tax receipt) cl Uvl?$ Ames Z-o t 0S IO Q � <br /> y my 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING n GARAGE/ACCESSORY STRUCTURE ADDITION rr <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: Cady n � C� <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) CD <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In 3 3 W <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. I ^ <br /> c V' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> :!! O Z <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 <br /> NORTH(N). VCi (✓^ ` 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ( P <br /> 4. SHOW THE LOCATION OF THE WELL(N/), 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'o <br /> o J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a 0 CJI <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: I (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. g <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. 7� <br /> 5. IP CD v O <br /> Zai <br /> ,* o ats a� � �u� ld� 3 a W 0 a <br /> 6. ����(� ylce Cei^ �a a� Qc 3 c 0 C N y o <br /> O <br /> 7. 5�.�-.fes. c37�'l J'1(M - "•— O cn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c <br /> c i <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C^ m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsi i g whether to is- <br /> sue apermit. I further accept all liability which may be a result of. ttr�r g i information I am m <br /> providing in this application. I agree to permit county officials c it a i $din o antes or other d? m [ I <br /> authorized person a access to the above described premises 14r�f the pur s�of inspection. T <br /> _ tD <br /> 4 QQ ; <br /> SIGN HERE 1 4 ��• �� <br /> ture of owner r uildln ontra ate) \ <br /> ZONING ADMINISTRATOR ETT COUNTY <br /> ZONMJ <br /> N N <br /> (T U•0 01 N O <br /> TOWN HIP PERMITS MAY BE REQUIRED o o o <br /> 000'0'M <br /> N0N0(0� 0 <br /> 0 <br />