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Burnett County7410 Co. Rd. K, No. 102, Siren, 61)6_VLrJ <br /> WI 54872 Office of Zoning Administrator a c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> ^' r <br /> O <br /> OWNER /� p w <br /> fiSC�GK /\ �O r! 'P7 Cf,,- TELEPHONE 7�j [�t7f'—C��9 7 SZ� <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER 6 ZO /and ROAD NAME �L,���s � )02 <br /> a��)Yb/fid <br /> LEGAL DESCRIPTION(see tax receipt) f pff 3 a 6ogl r f S 3 <br /> �61o, 1 <br /> o r/ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSOR/ 2xY STRUCTURE_ ADDITION C 3 <br /> _tra <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION 0 E' <br /> . <br /> STRUCTURE/ADDITION USE: 'g�fJO/ —/! <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) -� <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR R < <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T c3. <br /> . <br /> DIRECTIONS FOR PLOT PLAN DAWIN • (AERIAL OR TOP VIEW) <br /> O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. III CL <br /> .'Zo <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEWBUILDINGS(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 INTI 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 ' 1' <br /> ISSUED, Cr o �Jo <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. i <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 OH <br /> WM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. Si-,�.fcr.e <br /> 6. <br /> 3 � �'rF�� 7m0 <br /> 7. <br /> 'o <br /> of � mo `Oi <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my i g x <br /> M <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize I C CD <br /> B ? m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ' 6 <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 or other m <br /> authorized person to have access to the above describeCD <br /> d premises at any reasonable time for the purpose of ins ion. <br /> -n <br /> r) <br /> SIGN HERE <br /> (si store of owns o building contractor) t ;i (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIIIED-i o 0 0 o g 00 <br />