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&7 67mp <br /> Burnett Cgunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -u o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> N w g <br /> OWNER ejS�,t�hu./J I C_ TELEPHONE w <br /> HOMEADDRESS 3�a5� `J ,�I tO(�, �L}�� VUTAJSCe� Ulf <br /> EMERGENCY/FIRE NUMBER ROAD NAAME rl1�aj b(-d LAke o e <br /> 1 �1 <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) i y IU1(, <br /> n <br /> v. <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE y o <br /> ADDITION v <br /> 5 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONCIO <br /> W <br /> C yy) 1 / �� I (J <br /> STRUCTURE/ADDITION USE: yl 1 1 V, I � p" S—a�� � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR `J <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. I t fl <br /> 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING? (AERIAL OR TOP VIEW) p 2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0' D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a <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 c <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a <br /> ISSUED. 2 <br /> i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o �I <br /> CONDITIONS OF PERMIT: V <br /> V 1 <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 /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> �zg, _ 3 � � m <br /> 7. Zi '� '9 =j <br /> o : <br /> m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my IS <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d I C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o'em <br /> that this Information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d p <br /> sue a permit. 1 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 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. - <br /> e : <br /> SIGN HERE <br /> (signature of owner or <br /> building contractor) (date) <br /> wn <br /> ZONING ADMINISTRATOR J1(n, 1 l�'7 IIG�a� <br /> iN NNNfANc- <br /> K) <br /> p O N P P. <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />