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ofuCcr� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> .. r <br /> 0 <br /> C <br /> OWNER �� � �/ TELEPHONE �/S —��J?.S�%3� a <br /> d <br /> HOME ADDRESS ��� �' � � �1� GCJ.Co • S\70�� 0 <br /> EMERGENCY/FIRE NUMBER 4135 ' ROAD NAME <br /> 0 <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) DQ <br /> a <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION Cr <br /> a <br /> 5. <br /> w <br /> SANITARY PRIVY FILLING//GRRAA]DING CAMPING UNIT,,,, �o�SUBDIVISION,�I <br /> STRUCTURE/ADDITION USE: / 1 "�`c/`"�' 0 I e� � Er <br /> `5 <br /> (Home/Cabin;Commercial Busine ; Bedroom;Deck;etc.) T 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 B <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m 'p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C S (b n <br /> NORTH(N). ca 3 <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, z <br /> STREAM OR RIVER. 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 /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. �3 ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c C3 <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 /> rnkst be ua�a >�r 5i v� olifs *�& �''�" <br /> 5. St' Rw_,Id/ <br /> u M OA,1 if r <br /> z � � go�£ov <br /> 3Fa�P � <br /> 6. m e— <br /> v Cw o <br /> ': m <br /> I declare that this application (including any accompanying schedule) has axe b st of my ? C <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am res P tPre detail an a curacy of a� <br /> all Information contained In this application(including any accompanyin sc edule)and I further dec a nize o o : : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ` C <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 reasonable time for the purpose of Inspection. m <br /> -n <br /> m <br /> SIGN HERE <br /> /',7 <br /> n ture of owner ding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> wwwhH40 <br /> N NP P N N n1 <br /> V7 9"0 N U1 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />