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&L o >y <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v o° o <br /> APPLICATION FOR LAND USE PERMITS . <br /> U) <br /> II ._}_ <br /> OWNER 1_7_6 Aj IjQ4Qerr l TELEPHONE (Q%a- y5� -73s� o UA <br /> / ��� IJ AA,KS C Lur <br /> HOME ADDRESS �` Nuer C hc�U2 mn� SS�7� 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME f"Ardu, Q r <br /> .{- <br /> LEGAL DESCRIPTION(see tax receipt) d I / CSrvI tic) <br /> m <br /> o) 7 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-X--GARAGE/ACCESSORY STRUCTUREDDITION <br /> a <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> STRUCTURE/ADDITION USE: pal <br /> (Home/Cabin;Comm tial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR �. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> 7�0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n N <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m c ;IDD <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE nn t7 <br /> NORTH(N). y 3 <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. c <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 i <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q ° <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c `� I <br /> CONDITIONS OF PERMIT: <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. rr11 ll <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, DO <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. 1 r / <br /> 5. �I/O J�or7/Uti O t/WGI11 /©cc,�, Td+n�� W4ltS e�7. ��' 6 t; A v 0r.- o 0 -0 <br /> 6. C '°S�4Cr �nR/" S� U/ti`G.1M �}d S 3 'o��-gj' m °. m a <br /> v CN �' ° F. <br /> 7. oZi N �2 <br /> _ ca i i : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G0 C C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> m <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this in I m <br /> providing in this application. I agree to permit county officials charged with adm nl : (D E E <br /> authorized person to havj access to the above described premises at any reasonab i h a jj s i ., m <br /> mE <br /> 1 / <br /> SIGN HERE 1 Q <br /> l <br /> is ture of owner or uil Ing contractor) FED I( e \ <br /> ZONING ADMINISTRATOR <br /> bUFtNffff 01 <br /> N N N <br /> ZONING rip 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED �0 0 0 0 <br />