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9146 <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o <br /> APPLICATION FOR LAND USE PERMITS a 4 <br /> r: r <br /> N 0 <br /> C <br /> AI <br /> OWNER Ch��oKo Ohl F- <br /> TELEPHONE <br /> O <br /> HOMEADDRESS n' T7 l ^ICk <br /> r m <br /> buc` L` 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> l <br /> LEGAL DESCRIPTION(see tax receipt) I�OV rs r i�J— /���(� w <br /> i� <br /> 0 <br /> W <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION it <br /> Lai <br /> 5 _ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION (( <br /> � <br /> y " ` <br /> STRUCTURE/ADDITION USE: CSS i � S_ � <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. r <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) T <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. 0 <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. <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. c <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE '" 0 <br /> ISSUED. g <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: oro <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. IUUU` <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. 2 <br /> m <br /> 6. $� 3 ' 3 NA <br /> 9.',� vC(08 3 <br /> 7. Z : ymQ x`00 '4 <br /> o : <br /> Cn m <br /> 1 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 d C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize e 0 m :` i M <br /> Y <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- � 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 n <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. T <br /> m : <br /> e : <br /> SIGN HERE yr <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> J hHh N Oft <br /> P PP5n PPP <br /> TOWNSHIP PERMITS MAY BE REQUIRED o Coco o 0 0 0 <br />