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Di cc ' <br /> Durnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 w <br /> P <br /> N O <br /> N <br /> W <br /> OWNER JA/U G Q Q n TELEPHONE o <br /> w y� � <br /> d <br /> m <br /> HOME ADDRESS -1721 -rA AJ (v e yS��� wI 14G�3 <br /> ( m ` <br /> EMERGENCY/FIRE NUMBER <br /> � � �� ROAD NAME TAar>/504 /Sa`r RW- L` <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) f E e 2$— 7'x/0 yo A"5— /CL ( f I CO) <br /> 0 <br /> C>6 c o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTUREADDITION o 0 <br /> a <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> co <br /> STRUCTURE/ADDITION USE: rOQI.I� 'Crwty� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T 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). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rn <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 11 P <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> 0 (y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <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 /> n N O O 0 <br /> 7. o <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of �} o E : _ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ` t7 <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 <br /> authorized person to have access to the above described premises at any reasonab f fo a ur ose of ins ection. m <br /> C, — — - <br /> T <br /> SIGN HERE � ol'S'efl /?ot// 1e 5 L/v <br /> (signature of owner or building`contractor) (date) <br /> ZONING ADMINISTRATOR `\)Yl (�I `� v) �d�' JUN 2 3 j998 <br /> N CA P N NN (T <br /> N VIOut (rOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY 0 0 0 0 <br /> 0 0 0 0 0 0 0 <br />