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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 64872 Office of Zoning Administrator a DI 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER A1c,&dA C4404 „spm TELEPHONE 715- 273 - 455" o 6 <br /> m <br /> � <br /> HOME ADDRESS N • 70f4f _ 530 ThBt <br /> . St. 10 mviA& � tl 0 54W3 O <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME S11,4j4w 1f0H0 1 <br /> LEGAL DESCRIPTION(see tax receipt) (fit 1 flit tr U 'V 38 m { <br /> 8 <br /> rn <br /> e <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> CL <br /> S. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION c W <br /> rn <br /> STRUCTURE/ADDITION USE: re" B: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE ORg C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _n 3 <br /> .'O w <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 0 m <br /> n c <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 10 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). QQj _ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO (a �0 <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. ( a <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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 o I <br /> o 0 c5- <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a o. �J.➢ <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t <br /> ISSUANCE. V <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 UNL SS SPECIFICALLY PERMITTED.. <br /> 5. <br /> 6. e � <br /> 3 <br /> 91 C w � <br /> . <br /> 7. Zi mua <br /> o : <br /> ` Vim: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my g p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of '• 'm S <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 m <br /> providing In this ap tion. I agree to permit county officials charged with administ rjn _county ordinances or otheri <br /> E m E <br /> authorized person yo hillive access to the above described premises at any reasonable ti o e } oserof inspection, m E <br /> SIGN HERE ; %r <br /> signature of 6wner or building contractor) ; �W (rat@)J 07 <br /> { <br /> ZONING ADMINISTRATOR ( (' A11 t <br /> wwhh�wH� <br /> - U �n o p p 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED - - - — 0 0 0 0 0 0 0 <br /> IOC-z�elTr (o-0'17 <br />