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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N o <br /> OWNER Will I ftrr% t 1 `o r TELEPHONE ala-- 4d3-39 fog v <br /> m <br /> HOME ADDRESS Ci <br /> , e—F_�(EL al'u5t 1'I)DIe oll t NN ss/ac/ � U\ 9 <br /> 1 s <br /> EMERGENCY/FIRE NUMBER ROAD NAME tJe.?hair— -h'2t✓� ~ <br /> 1 <br /> f_ot (01 CR 5fn \/*I y pis 9(,197, bG�N� pa�-Fs w14 _- <br /> LEGAL DESCRIPTION(see tax receipt) Lot-,, 31 3A 4 33 Plat df HA PSCAM 1.o�ticShores I O�.fi�d `� o' <br /> rra Lo 1 +S/ Id-SIO-I�/ ur r�cTtk � y o 1� <br /> TYPE OF PERMIT(S):DWELLING/B UILDING _GARAGE/ACCESSORY STRUCTURE ADDITION ' 7 <br /> a <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION � <br /> nn ca <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) T TI <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR I <- - <br /> ILLEGIBLE <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. C S� <br /> 0 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C V n <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, 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. `L <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,3 o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> 4 � <br /> ISSUED. Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: �) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT i <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 PERMITTE . <br /> 5. �('�i C�t�f/� <br /> 6. _ db• 3 n <br /> 7. c <br /> _ur i m <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 I 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 ° !r m m <br /> that this information I am providing will be relied upon by the County of Bumett Wisconsin in determining whether to Is- y 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 iu p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E m <br /> authorized perso to-have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> CD : <br /> (D <br /> SIGN HERE _ � • • <br /> (s a of owner or builds o ctor) <br /> 1 date). <br /> i J <br /> ZONING ADMINISTRATOR ' OW 44 4 Wf .n <br /> (A WNHhd1 <br /> J <br /> •� N Nps NNtT ut <br /> ✓� i f ? '� .:. u t V I O P U O O <br /> TOWNSHIP PERMITS MAY BE REQUIR f -')i 0 0 0 0 0 0 <br />