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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 C 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> vww <br /> 53 <br /> o <br /> OWNER TELEPHONE 7I� CAArO 0 , VoAUK Z® S { <br /> 41 0 <br /> HOMEADDRESS 7Z AUfC00rrnnAO <br /> 1 AS f't'I fJ <br /> EMERGENCY/FIRE NUMBER :30U SROAD NAME ro <br /> ti, fi� �,� , t� O <br /> LEGAL DESCRIPTION(see tax receipt) `-GOV �+s �,3�``y y <br /> �f y CS v �3 P t5& 8 <br /> Q <br /> N j <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION Cr <br /> n <br /> 5. 1 <br /> o' 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION— <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: CA b 1 hl Pi6 � � <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) 3 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE O Q � T 3 r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. —F1 <br /> /— , w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) l /f OT�`r o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn n <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO n1 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. ` `2 <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. o' o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a ° Q� <br /> ISSUED. <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. F <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 -ut7r;- vkv -0 <br /> �. Qa1m <br /> 6. � a Q_ m <br /> St <br /> � Cin7. <br /> �" oS3 <br /> o : <br /> y i T <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C p E S <br /> all Information contained in this application(including any accompanying schedule)and I further declare that 1 recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- . . . O <br /> d <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 i <br /> authorized person have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> r7 ( i <br /> SIGN HERE <br /> ( na roof owner Iding contractor) ' (date) <br /> ZONING ADMINISTRATOR H <br /> � N N O fT UNi00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />