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Burnett Cqunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 0 <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> • " r <br /> OWNER /nfId �� Q�dal gf.! .L• � <br /> 3 -711 �JG At w- <br /> -/c/'�'v TELEPHONE03 <br /> byCl '4't I� o <br /> HOME ADDRESS <br /> o. & �sC6� DC7 <br /> EMERGENCY/FIRE NUMBER ROAD NAME 0 <br /> Cn <br /> Oro o Ks IF/ a © cc - <br /> LEGAL DESCRIPTION(see tax receipt)�' if r <br /> ^�n <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE�ADDITION c <br /> at9 <br /> 5.� <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> cy <br /> y <br /> m <br /> STRUCTURE/ADDITION USE: �Q <br /> 6 <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 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O 3 <br /> DIRECTIONS FOR PLOT PL6N DRAWING. (AERIAL OR TOP VIEW) C <br /> T - A z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m IF <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m -- 3 <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. <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 c <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. Cr <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 /> P NDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. —q 1% 5 e A4' 1e66-�- 4-t-o m t2oodO . <br /> g. ,W <br /> 6. = m; CD ?gym <br /> 7. <br /> v • <br /> '-1m: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 3 c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of pQ o.a ': C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o ; m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i ip <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 administp�ng m ' <br /> (III T ty ocothe `o <br /> authorized person to have access to the above described premises at any reasonable ti a or the purpose of inspeC}for�r P <br /> m : <br /> Io <br /> SIGN HERE _ h E <br /> (signs owner or building c V r) , <br /> Ids <br /> ZONING ADMINISTRATOR <br /> fR N fA ro <br /> N N N NK) <br /> N En N N <br /> N pI O fT G1 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED `""— -- 0 0 0 0 0 0 0 <br />