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;art C YY/ <br /> Burnett-County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator M o° o <br /> APPLICATION FOR LAND USE PERMITS <br /> o <br /> l dnv <br /> OWNER v Ca r l O 11 `�_� e.n TELEPHONE I y - (0 3 -`1 S$ a <br /> m <br /> O <br /> HOME ADDRESS , �o (� Q H P-C Z11- `� c <br /> EMERGENCY/FIRE NUMBER r✓{ lc ROAD NAME I I 1 ey-I"<, L <br /> 0 <br /> -��� ca <br /> LEGAL DESCRIPTION(see tax receipt) Pia , � ' �7 L� S� �� I J"/ d �'C �4W a <br /> m <br /> 0 <br /> y � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE------ADDITION--X— or <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ca <br /> 10� car i lir <br /> N <br /> STRUCTURE/ADDITION USE: �t9�'1 <br /> (Home/Cabin; Commercial Busine s; Bedroom;Deck; c.) a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 "ls� <br /> (� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 a f� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. fill <br /> 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C c <br /> NORTH(N). W g <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(OHM)OF LAKE, c <br /> STREAM OR RIVER. Q J <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 2. W <br /> MUST BE SIGNED AND DATED BY THE OWNER. o — <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 3 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: 90 <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. �}C(�c.�,fiuw�A�ferc�h� IS N� � �> �XcePr� S 'a0 20�aM <br /> L <br /> 6. v Cm : <br /> of wT'Z : ?� � <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ? �G�S 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 m m m <br /> that this information I am providing will be relied upon by the County of Bumett Wisconsin In determining whether to is- ; d <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. - <br /> SIGN HERE <br /> (sl of owner or uilding c ctor) (date) _ ! <br /> ZONING ADMINISTRATOR <br /> � gN(ANNMH <br /> N N U N N N N <br /> I1..��.��+ - -i�..-i N N O 0 0 O O <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` <br />