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O/A C <br /> Z <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator 3 L7 0 5 <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERI 1TELEPHONE I2/ �' � / mn <br /> _ lu <br /> HOME ADDRESS -7 CDIlee n /up <br /> r <br /> o <br /> m& Wr6� QCRQV9 5T °70„ <br /> EMERGENCY/FIRE NUMBER W r ROAD NAME <br /> i-0�'d 0 C&II, V0� ) Alfd1o�. N R17U> ca <br /> LEGAL DESCRIPTION(see tax receipt) CSV f ul f d / � T 3� C <br /> rn 0 <br /> c <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 5 ^^� <br /> E l <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION N <br /> fit <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) 3 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 0 ° <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. X pa <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 9 <br /> � � <br /> C � c <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N 3 <br /> NORTH(N). m P <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, o <br /> STREAM OR RIVER. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TOB ca <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 �. v <br /> MUST BE SIGNED AND DATED BY THE OWNER. p i So <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr S <br /> ISSUED. Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Pc� <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I y <br /> ISSUANCE. <br /> CUTTING2. REMOVAL OR <br /> 3. NO GRADING OR HO ELAND A TERATIONS ARE ALLOWED UNLESS SPEC F CALLIS RESTRICTED ALONG YLINE . <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. ccpp <br /> 5. <br /> ;a -V <br /> )F L m <br /> 6a ` H <br /> goo <br /> . : m i <br /> Z :7. <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my G�r <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize t7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- <br /> sue apermit. 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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. CD <br /> - , <br /> m : <br /> SIGN HER <br /> (signature of owner or building contractor) I / <br /> H 40�� <br /> ZONING ADMINISTRATOR i '1' o p p p p <br /> orscnoo <br /> 00000 <br /> TOWNSHIP PERMITS MAY BE REQUIRE7 <br /> w <br />