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�l CC\1� <br /> Uurnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o° o <br /> APPLICATION FOR LAND USE PERMITS . < p <br /> V <br /> i� o r <br /> N <br /> ///�.�� / C <br /> OWNER �eyry � L�Q TELEPHONE o <br /> m � <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME (tJ/ L� 1� <br /> LEGAL DESCRIPTION (see tax receipt) � m <br /> ASN R150 <br /> rn <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION iz <br /> � g <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> f a) <br /> STRUCTURE/ADDITION USE: S' 73139 <br /> (Home/ bin; Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> �J N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c <br /> n a <br /> n O Z <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). Cn o <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 AND MEASUREMENT TO WETLAND AREAS. 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. - --C <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 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 9J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a ° Q <br /> ISSUED. �- 1� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ` <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( `r <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �p <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 /> 'OpD 'O <br /> M M. M. m � iiMO � <br /> M <br /> 6. mm <br /> � � aNc - <br /> mC= <br /> N0 tO <br /> 7. o <br /> = Cnm <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of o c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize {�+1' m : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- V G <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. -n <br /> Q : <br /> M : <br /> SIGN HERE <br /> sign ure o ow r building contractor) (date) <br /> ZONING ADMINISTRATOR 69 <br /> N NfT N N1� <br /> N (T V O O <br /> O OO O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 00 00 <br />