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Burnett tounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator I - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> � r <br /> OWNER 1 TELEPHONE ,;� 775 C <br /> J21AZ C2 <br /> f/ <br /> HOME ADDRESS <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER )06 <br /> O NAME )!J <br /> 1 , I I /r r \ <br /> LEGAL DESCRIPTION(see tax receipt) �� � C'Sfn V. �' p, �) y <j,, �, � 1 9'""ib�t� I (n <br /> N <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING— ; GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) v <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 /> x c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). W O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m (1 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ~ 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. SU <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEa ° <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <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. u <br /> 5. 7t�� /(5 Or <br /> r Tcc� 4/0fl- t'd'" m -0 d r. M :OE m <br /> 6. <br /> A ' V N C N N 0 J �_ <br /> /I / / N N <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (n` c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of } o. `: C <br /> all information contained in this application(including any accompanying schedule)and I furthWunordpin <br /> fiat I recognize m m <br /> that this information I am providing will be relied upon by the County of Bu fr ether to is- y '• ' ` O <br /> sue a permit. I further accept all liability which may be a result of the Cc .e me Ii frination I am m <br /> providing in this application. I agree to permit county officials charge'' r cgs or other <br /> r <br /> authorized person have access to a above d premises at an asonable time for the purpose inspection. m <br /> CD <br /> SIGN HER <br /> MAY22 � <br /> (sl at -e n Ildin cont or) BURNETT CQU(v( ) <br /> ZONING ADMINISTRATOR <br /> to v+cn to to vi <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />