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� Cr,)tiLp, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> 0 � <br /> OWNER C� eii— Ar/J ,C S' TELEPHONE 7/57 _R��C,3030 ^p <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBEROe KI A-riA 7 oZ Co 7 ROAD NAME '-'son IQ <br /> L64 2A C 5At' / l° /GZ /�G[- 00 <br /> � r <br /> LEGAL DESCRIPTION(seetaxreceipt) GurV Lu DES I r✓ V .�7/ /bS3 � C <br /> y <br /> 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> a <br /> w' <br /> SANITARY PRIW FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> m <br /> STRUCTURE/ADDITION USE:6L✓ I t"h <br /> CL <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> ' < <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. —' <br /> c 1 <br /> -n a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O C v <br /> � Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m23 <br /> jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> n <br /> 1- 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. DQ 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. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 0 <br /> ISSUED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (�—1 <br /> ISSUANCE. v <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 <br /> �UNLESS SPECIFICALLY PERMITTED. <br /> / <br /> 5. S �� SP/ f�//` � iIZ, �STot/O c L67 <br /> v4 S �0 v n r O 0 "' <br /> 6. �peg,^( 6e / /eQ Jt r--1 O„" G D �.e !> 9 v C w �" o <br /> 7. �f Z `�" �� <br /> p : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of � m a C <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �E '• m m <br /> that this information I 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 <br /> authorized person to have acce s to t0q above described premises at any reasonable time for the purpose of inspection. T <br /> 1 � <br /> SIGN HERE O a H <br /> Ig�nat�ureof ow or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> fAHHNiNN� <br /> N N I11 N N U1!J1 <br /> fJ1 (JI O N fJl O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />