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Burn"County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 c� Z <br /> APPLICATION FOR LAND USE PERMITS ° <br /> ^� r <br /> CO fT'T' 1 rn o <br /> OWNER J-C'r/S m e S ,mrr�n1 K ;• > , TELEPHONE l 1 4- 4Q.3 g�?4 p w <br /> HOME ADDRESS J 1 0 <br /> X59 I UU , �`(lc�ni eu�ood �r I ,.�� Green A�a(,�wT <br /> EMERGENC FIRE NUMBER p Prl u o Q or' <br /> d fJ 3 5 -L ROAD NAME <br /> 4/ 51d8o1Ajj77//P1 Si4/ rho/� �y�cdGdfJceEs ,�- <br /> LEGAL DESCRIPTION(see tax receipto/T'JOO <br /> 12 -�kd,_ /y_ 36_ a <br /> u 3 .y c <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGGARAG ACCESSORYSTRUCTU ADDITION y <br /> c <br /> c <br /> CL <br /> 5. �. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION f „� <br /> 500-t rn <br /> STRUCTURE/ADDITION USE:_ 15i r d e <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) -1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> O <br /> w <br /> DIRECTIONS FOR PLOT PLAN DRAWING7 (AERIAL OR TOP VIEW) 0 <br /> n & <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 .. Z0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m � <br /> NORTH(N). Cj n <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, <br /> STREAM OR RIVER. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- o <br /> INGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. DIPN <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. 0-i _ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 3 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. / <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �J I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS)RIVER UNLESS SPECIFICALLY PERMITT <br /> 5. <br /> Sid IU be s-jc �-v &a Pr/u,�,fe j3614 <br /> ;a -u Q r O O 9 <br /> 7. : a m 8 <br /> c 1 <br /> E <br /> =yM: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c i O <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy ofm C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m i i i m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is <br /> i p <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 <br /> authorized person to have access to the above described premises at any reasonable tim <br /> � . m : <br /> SIGN HERE ��' i�^ <br /> (s na re of owns wilding contractor) Idate <br /> ZONING ADMINISTRATOR f ( )� IN"$ <br /> Ln <br /> NO NIT OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED0 0 0 0 0 0 0 <br />