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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 07 0 <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> r <br /> w o <br /> � tr� <br /> OWNER �e�h^ r I TELEPHONE61� - L/S .Cj/��0 a (J( <br /> HOME ADDRESSO 1 <br /> ) %910 ,��„ � hn r� l q n � �nVer �fcsUe A1f5 /11,[� 55���6 � <br /> r <br /> 0 <br /> 1 n .. <br /> EMERGENCY/FIRE NUMBER Sl� ROAD NAME f Ic rnLke Kng l <br /> .SE //y AlE %y, 5-7 + 40 ti Town o{' J4c. -SGn <br /> LEGAL DESCRIPTION(see tax receipt) &CAP }t 0oun��, ; (nJT W y <br /> N 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ADDITION c <br /> Q. <br /> S. <br /> , - I o� <br /> ' <br /> SUBDIVISION <br /> SANITARY NT <br /> &(STRUCTURE/ADDITION USE: whP4\ <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR �/A[000 U+ir <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. `�^(, 47 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) pw �,`(,(j ow 4 0 Q <br /> new mpot l� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. I i(Q Q m <br /> 3 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). W o <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. <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. i <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I <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. m o <br /> o � 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: .)CJ ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT G <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, RIVEAR UNLESS SPECIFICALLY PERMITTED. p <br /> 5. C/ �e3VI�OSL/ �j,+zf �`L �5 T Jam/// = n G O <br /> 6. <br /> 0 A <br /> 7. �f ,oZ i N x <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my g C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i : m m <br /> that this Information I am providing will be relied upon by the County of Bumett Wisconsin in determining whether to Is- 0 <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 f m <br /> authorized person to have access to the above described premises at any reasonab a for the purpose of inspection. m <br /> SIGN HERE <br /> (s of owner or bui In ontractor) �' (date) i <br /> ZONING ADMINISTRATOR H N' H <br /> NNra N <br /> TOWNSHIP PERMITS MAY BE REQUIR '"" 000000 0 <br />