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Ops C0'vlPU R ER/Si AIMED L15) <br /> ' <br /> B7frnett'County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator M o o <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 <br /> OWNER !7 OL4 I SC /• 1 11 LLE/ TELEPHONE `S-C�3,S''aP_ 3S p <br /> 1 - p / O <br /> HOME ADDRESS 1,5_9Y- L <br /> I)OCk 4)(E /� D �OAJZ/f YVl &0 <br /> r m <br /> EMERGENCY/FIRE NUMBER �Sg' ROAD NAMED64 L,46: )f b <br /> LEGAL DESCRIPTION(see tax receipt) S/Y1-r.-37 /R/7` W 5 wly "SF �x 'd/0"fic C <br /> y o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE--X—ADDITION— <br /> SANITARY— <br /> TRUCTURE--X—ADDITION SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> ,30'Y <br /> ,3O/Y_ / d y <br /> 7 <br /> STRUCTURE/ADDITION USE: 570" CE BARN <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n $ <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 C n <br /> NORTH(N). N o <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, <br /> 0 <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. S(J <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a B <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. PZ �^ <br /> CONDITIONS OF PERMIT: <br /> IN <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. A � mm o�ov <br /> C n <br /> A <br /> CL <br /> 6. i w <br /> 7 0 : o N o m ; <br /> Z � ' i <br /> : <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zf o C <br /> knowledge and belief It is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of o >r : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mot : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is m 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 <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 /> a, <br /> m : <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N N N N N V <br /> fJ1 pl O N(JO O <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />