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00 Ceyr'/D, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator R o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> w <br /> OWNER © i�k Shehr�l C S CQ N� cN TELEPHONE 6 ' -j atD' n�$$ O (n <br /> HOME ADDRESS �5 � � fltoe� QVC � dltJfl M1atJ- 5591A r <br /> 0 1 <br /> 01 <br /> EMERGENCY/FIRE NUMBER AA 5 5 G U J pa �a ROAD NAME , ~ <br /> LEGAL DESCRIPTION(see tax receipt) I o A 5 k 1 3� N '�15v1 ) A��ye p �U)NJttt Go 0 <br /> cr <br /> 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTUREADDITION—X— <br /> c <br /> CL <br /> w' m <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 �{} <br /> \ Q m <br /> STRUCTURE/ADDITION USE: t_AKere,rn%h-t- �r <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) LA <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <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 <br /> NORTH(N). a O <br /> ca 0 <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. 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. �L <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 1 <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 BEa 0 <br /> ISSUED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <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 /> A . 0r gagO -0 <br /> 3 n lFa 7m0 <br /> 6. 40 cc <br /> er = <br /> m <br /> 7. c N IQ ' � <br /> =v+ € m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my .W c3 ff i r <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of K} <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m Is m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 <br /> authorized person to have a ess to the above described premises at any reasonable time for the purpose of inspection. T <br /> SIGN HERE itua <br /> (signature of own or building contractor) +,ffirr (date) <br /> ZONING ADMINISTRATOR I I u <br /> fn w w w u w <br /> N(TNNN(n <br /> TOWNSHIP PERMITS MAY BE REQUIRED !" ,-l_. _ 00 0 0 0 0 o <br /> 0000000 <br />