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Burnett County-7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v o <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> w � <br /> OWNER 77.40, eM A9�A d, su rLLF`/� TELEPHON( /per S,6 , w <br /> S� GQ <br /> HOME ADDRESS / <br /> 107` T/lU G K1 06 J20 <br /> EMERGENCY/FIRE NUMBER �IWOL/F/J �DirZ ROAD NAME &)- G/oPSj)J cX 0?, ti <br /> i r <br /> LEGAL DESCRIPTION(see tax receipt) y <br /> Q <br /> N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION � <br /> c <br /> n <br /> a' <br /> SANITARY PRIW FlIL/LING/GRADIN/G�� CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: T7 b�/� j�T)V l C�"I4�T�YY 1 (D <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) v 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. r ^� <br /> 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) r $ <br /> T ^ Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C V 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO U) <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 DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS, ROADS, LAKE, LOT LINES. f <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. L <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 6q I_ <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o 0 f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE '" 9, <br /> ISSUED. cqj' <br /> Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. e <br /> CONDITIONS OF PERMIT: t <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. O <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 /> z -0 m; o9om <br /> 6. � � aa 1 ; <br /> � ao � m � <br /> 7. o :z : <br /> I declare that this application (including an accompanying —H ` m <br /> pp ( g y panying schedule) has been examined by me and to the bast of my g '• ; 10 <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 I further declare that I recognize a o . : A <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. 1 agree to permit county officials charged with admin e E m E <br /> authorized perso ave access to the above described premises at any reasonable Ft rposa of in* <br /> SIGN HERE I <br /> sig store of own building contractor) <br /> H <br /> ZONING ADMINISTRATOR w <br /> • N NNNNfNll tr <br /> in Vt O N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 o b o o <br /> y 1)c <br />