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On C-C'1VW <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator c c <br /> -V / <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> d � o <br /> CD <br /> OWNER TELEPHONER<; G �l Q �[ -a S- <br /> 1 m <br /> HOME ADDRESS Z O <br /> 02 7 l -5 / L �� r R 0 �.v� i3 CS TE l2 �l � <br /> EMERGENCY/FIRE NUMBER a / l� 1 ROAD NAME <br /> Q <br /> LEGAL DESCRIPTION(see tax receipt) _ <br /> 1 <br /> C <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION_ v <br /> n <br /> N ?- <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: Add. SeIwAj Arc. fir ((A <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. C <br /> 0 w \ <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0 <br /> FL <br /> M Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C _ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <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. ,-0 � <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 64 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m of <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE r ^ <br /> ISSUED. v 1 <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �d <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. <br /> ;a -U 03 (D rn <br /> 3 CL' n <br /> 6. OC�Ni0 <br /> 7. <br /> _m ; <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofWm e_ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D E E <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m i <br /> authorized person to have access to the above d ribed premises at any reasonable ti e}Lurpose of inspection. T <br /> SIGN HERE s a�a�tc� '� ,' j CHt, <br /> (sI re of ow r r building contractor) (date) <br /> ii �'�j <br /> ZONING ADMINISTRATOR I�, 1 S& E i E '• <br /> www w <br /> TOWNSHIP PERMITS MAY BE REQUIRED "—`� J 0 0 0 0 0 0 <br /> a.drrL. <br />