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Aett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o c <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 (� ` <br /> (n � 'V <br /> N 1 <br /> n <br /> OWNER To yt TELEPHONE (�/d-' Vd3,7o3 j o <br /> w <br /> f J/ ,/ O <br /> HOME ADDRESS 15 q 7 1 �rc x—e�-I �� �/ Agele lO�� , �? <br /> EMERGENCY/FIRE NUMBER Sec- I OYt / 7 ROAD NAME L�qq �(qkle- o <br /> LEGAL DESCRIPTION(see tax receipt) Z-ot,3 C-S/'l v 7 V. LO! <br /> o <br /> ur � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING�GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> 5. rr <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION M <br /> rn 1 <br /> m <br /> STRUCTURE/ADDITION USE: <br /> Cab /'n { ;lig <br /> (Home/Cabin; Commercial Business/Bed room;Deck;etc.) "a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR _n 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> (h� <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) 0 ii <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v Q <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). fA <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m "\ v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. rllt� o <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. N Qj <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 2, <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ar <br /> _ <br /> ISSUED. 0 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <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. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 9 <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. <br /> -0C)y citf m <br /> OM � � nM" x <br /> 6. <br /> � m C m . <br /> 7. <br /> o : y < : A <br /> = rn: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my t7 ! c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C" m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 described premises at any reasonable time for the purpose of inspection. T <br /> Q : <br /> m : <br /> SIGN HERE <br /> Z5Z y <br /> (sigTns ure of 6wwner or building contractor) (dat ) <br /> ZONING ADMINISTRATOR V ,II I <br /> v�En vi Fn an <br /> N N fn N N ul <br /> O(T ()1 0 <br /> OO O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 <br />