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0��1D <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator V o a <br /> APPLICATION FOR LAND USE PERMITS . `» <br /> fob 3 a u Iz� 6ia- <br /> OWNER `/�/ J C C,�. TELEPHONE \I m C <br /> HOME ADDRESS ��5 1Ydrbu1—LyY� SD. at, PRd , 0)JV 550_7"___) � 9 <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME Wa Ido ra <br /> , �1 C <br /> LEGAL DESCRIPTION(see tax receipt) ov'�. L l: a, /�r 39- (7 ca <br /> o <br /> c <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION v <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION--4— o'� <br /> Csm V - 01 d 1_4r IS -PeI9 I <br /> STRUCTURE/ADDITION USE: � <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. m ^� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m' Zq <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE c .r O <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a <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 GRAINFIELD(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. 1 <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 so <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 <br /> ISSUED. R. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: 7�7 V <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. <br /> Smog O O 'D <br /> �. m m <br /> 6. <br /> v Rwow �m � <br /> o : <br /> .y: m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my <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 1 further declare that I recognize $ w o f E A <br /> 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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> w : <br /> SIGN HERE <br /> (signature <br /> reof owner or building contractor) (date) <br /> ZONING ADMINISTRATOR I\(Y1 T�IV111G�f1 ' u <br /> W WWNNN� <br /> N N N N N N N <br /> U7 NO [nN 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />