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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator C/a V C Z <br /> APPLICATION FOR LAND USE PERMITS Ill ° <br /> r <br /> o <br /> OWNER 1 Jr L OA TELEPHONE 6,S-(; <br /> OX 00 <br /> m <br /> NOME ADDRESS '7 717 ICburin e kc: �'y IbIrsk Kul W:��G g ,, <br /> n j <br /> EMERGENCY/FIRE NUMBER �79 /y ROADNAME K�tltid LAKE ©Q i <br /> //U51Dt-400l Cafe //J4 )qck'�5 nu /N 7_1*:_ <br /> l <br /> LEGAL DESCRIPTION(see tax receipt) S W T y/ 2- l6 `J N <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION_ m <br /> c <br /> Cr <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a y✓ <br /> o' <br /> STRUCTURE/ADDITION USE:��nI� LQ <br /> fir <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. In ^; <br /> DIRECTIONS FOR PLOT ai AN na WIN 7 (AERIAL OR TOP VIEW) O m` y <br /> m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. M o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m $ <br /> NORTH(N). C n <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, <br /> STREAM OR RIVER. z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- o <br /> INGS,ROADS, LAKE, LOT LINES. W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N xJ <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. co <br /> c <br /> o 9 W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 2r. S �J <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW, pZ <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 1 <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�ufi �?ICc peck rvun�6e� am�wtit rNcl� 1e�o.� 5a,.�6. -. m r <br /> � a Lk Lkj ; <br /> 7. 0 <br /> w )i i <br /> _�: - rn <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 of m ` ; C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- a p <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 i <br /> e : <br /> SIGN HERE <br /> i n lure of or building contrector) (date) <br /> ZONING ADMINISTRATOR <br /> �,wurwwfnw+ <br /> N NON utOO� <br /> � : TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 0 <br /> c. <br />