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6-Y) c" <br /> Burnett Coounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> - <br /> APPLICATION FOR LAND USE PERMITS 3 A, <br /> OWNER_OHu y- )�4' Sj <br /> TELEPHONE 76— a / m <br /> HOME ADDRESS 1-13 j `CST LIV EL 6 <br /> o_ <br /> EMERGENCY/FIRE NUMBER a'g4Lo a ROAD NAME <br /> 4JV96 M ,CEN$fE 130 4UH 506 D1V15')o,V � <br /> LEGAL DESCRIPTION(see tax receipt) 1,0W a 3 041< ( -pee f�V GOT / ( GSC 4, ca <br /> �1 71-.0 �� 7� f A/..A 0 f r M <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION aQ-¢; <br /> 3 <br /> SANITARY PRIVY FILLIING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: GR,eAcoc-. i <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n c <br /> GO <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m � <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. <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. o t <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 9 <br /> o9 J� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a ° d <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o /� 1 <br /> CONDITIONS OF PERMIT: <br /> l <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 /> 0 0 3a i MX <br /> 6. v aC0 !" oo � <br /> two : qua <br /> 7. c ? 0 �2 : 1 <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS c E E p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o ` f c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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- d 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 m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other m i <br /> authorized person to have access to the above described premises at any reasonable tim n. <br /> SIGN HERE <br /> I nature of o r or building contractor) (Q tel j f <br /> nr,T I 1996 v <br /> to <br /> ZONING ADMINISTRATOR i I J ' <br /> I N NNNNfJi[n <br /> U tnON!! O <br /> 0 0 0000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED '0 00 0 0 0 0 <br />