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Burnett.County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 I 0 O <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> 0 <br /> c <br /> OWNER 4 IL p ,�p11 TELEPHONE (`/a) R 3 7 -a�-ti i v a <br /> HOME ADDRESS SRS/7 Cdr. Rd, ) S-5_14-/-7 O <br /> g <br /> EMERGENCY/FIRE NUMBER 7 (p ROAD NAME C f-y jq <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) ( i y esrn V. 13 ,p.o y �• L <br /> ig <br /> v. <br /> y � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION_ Cr <br /> CL <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> ca <br /> PC <br /> STRUCTURE/ADDITION USE: � Seero�, Q0" g <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) 4 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O $ IJ J <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S 'p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 m a <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. <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 o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 <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 v l <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 /> ;a -0 mm 0017 <br /> 6. <br /> wo � � <br /> 7Z w <br /> . o� =,a 1 <br /> o : <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c E E E p <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of a E S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ----4 R m <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other A <br /> authorized person to haveaccess to the above described premises at any reasonable time for the purpose of Inspection. T <br /> e : <br /> (D : <br /> SIGN HERE 7-3-77 `A <br /> signature of ow er or building contractor) (date) <br /> ZONING ADMINISTRATOR Jlnt c ° 4 w <br /> HNMN(A� <br /> to fNJ�OfNn fN7i00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />