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(-Vjn -J <br /> Burneit.County 7410 Co. Rd.K, No.102, Siren,WI 54872 Office of Zoning Administrator - 4 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER MfiR[� JO SQ GC TELEPHONE ,�29VV L m <br /> HOME ADDRESS �� 1,75 m o�✓e- <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER a 75C�L ROAD NAME&/pS�/�, <br /> JeFFr,cs ts� 9� ;` <br /> S/TS�O�.P/G,4J - / <br /> LEGAL DESCRIPTION(see tax receipt) /p-//o ff-0 L -r//o �i�� o <br /> ul._a <br /> V STRI V TI IRF A ADDITION o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSOR R. l� <br /> ae <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION m 0� <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 m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. X c <br /> DIRECTIONS AN D <br /> FOR PLOT PLAN (AERIAL OR TOP VIEW) n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> m ;bs <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn e <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m c <br /> M <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, v oZ <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. N l <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. l <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 5 c <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ° <br /> Cr <br /> ISSUED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° <br /> CONDITIONS OF PERMIT: I-, <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT v <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. Sfluit� Wt JT� IS�fim it/luanF�«Wi M "am0 0m <br /> CL M <br /> n <br /> o NM'2 <br /> 7. = cot ? m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS lo <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C 56 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> (J : C <br /> Wisconsin that this information I am providing will be relied upon by the County of Burnett in determining whether to is- m <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 d 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 /> SIGN HERE (date) <br /> (s at a of owne r u Ing contractor) <br /> ZONING ADMINISTRATOR 1 H u u`A�Eft 4 <br /> N N I" N N In Ili <br /> N Ili oNp OO <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />