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'f-;Tt o-)'VCP <br /> Burnett CouAty 7410 Co. Rd. K, No.102, Siren,W164872 Office of Zoning Administrator -U o° c <br /> M APPLICATION FOR LAND USE PERMITS 3. <br /> w <br /> OWNER / C Jl� G ropy n TELEPHONE (12 y20 33/? o <br /> 11 � ' <br /> O <br /> HOME ADDRESSUQ/l m'SAv fl Ln A/ a�rnf32-2 1 <br /> o <br /> EMERGENCY/FIRE NUMBER 22 ROAD NAME <br /> jj <br /> opc` `, ., G,/ I (O <br /> LEGAL DESCRIPTION(see tax receipt) S O 7 r fa is / (/ ; �g <br /> o, 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> 5. <br /> M. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> N <br /> STRUCTURE/ADDITION USE: _ p404.:s <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In '. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> x w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. I'll <br /> 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C ct <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M 3 <br /> c <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. ° <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. N 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0, <br /> MUST BE SIGNED AND DATED BY THE OWNER. m' O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE `" o <br /> ISSUED. <br /> .. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o G <br /> CONDITIONS OF PERMIT: n j <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 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 /> M w L m <br /> 6. a c '" > 3C <br /> w w o . m <br /> -ca m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS g ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCA: ? n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize w m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m t7 <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances <br /> authorized penton to have access o the above described premises at any reasonable time for the purpose of inspection. m <br /> - : <br /> w : <br /> SIGN HERE <br /> (s re of owner or building contracfpr) (date) <br /> ZONING ADMINISTRATOR <br /> H(A iRMN� <br /> N N N N N V t N <br /> N N O N f 11 O O <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED O O O O O O O <br />