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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator - a o <br /> APPLICATION FOR LAND USE PERMITS 3. 4 <br /> N o <br /> OWNER TELEPHONE g(; e,-_ JOrp O <br /> W <br /> / �/ Ir <br /> HOME ADDRESS //Z L = ��p ��o.�l �- W�� 5'� �2 0 <br /> EMERGENCY/FIRENUMBER pC ( �(�(� ROADNAME <br /> LEGAL DESCRIPTION(see tax receipt) 401 CEsm I/OI )'-1, pG 159 - e( -y0 - 13 UC) <br /> ca <br /> 0 <br /> N � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—ADDITION-.)(— <br /> SANITARY— <br /> TRUCTURE ADDITION c <br /> n <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> y <br /> , fi V <br /> STRUCTURE/ADDITION USE: 30kJ�'L-1�l�ti�a•^� f ���r/a cS-C`��2P�1. �lfir <br /> (Home/Cabin; C mmercial Business;Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> � H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <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 O <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 m ` z <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS (P <br /> MUST BE SIGNED AND DATED BY THE OWNER. n' o <br /> O � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEq S ` <br /> ISSUED. 2 C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: Q� <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. �ON0/�M��O/ja�, 0�-yD��IL ,�f-IVAYuJ,4k -- & te �G� 'q0/:W-10'' m o o m <br /> 6. 'I - <br /> 7. `Z ` ? � <br /> =y m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c . . . C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of E o <br /> all information contained in this application(including any accompanying schedule)and I 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- ; d G <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 E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized persoqlobqve access to the above described premises at any reasonable time for the purpose of inspection. m <br /> ` m <br /> SIGN HERE r <br /> gna re of r building contractor) (date) <br /> ZONING ADMINISTRATOR b0000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />