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M 0", <br /> Burnjitt County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> Da #9 rvs FAmIGY TRUSI -C <br /> OWNER TELEPHONE <br /> SN E Dc eX'I �s s6� - � � =� <br /> O <br /> 2 b/c'C <br /> HOME ADDRESS u ?j Zs Q A A/ <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER f ROAD NAME C Q � C O n Aq N OCD <br /> -/9' 392/3�o S �Tyo/R/7 � sicREs Tho ._ 2_ S'o _ 6 3oeo <br /> LEGAL DESCRIPTION(see tax receipt) (� y <br /> THE O nlFS AoT 34 K 3t-IC 1 <br /> y�0 <br /> TYPE OF PERMIT($):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE L/ ADDITIONo <br /> 5 <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> N <br /> / ar <br /> STRUCTURE/ADDITION USE: ,z <br /> 1 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> it <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. w �l <br /> c �I <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE y .. _ c <br /> NORTH TO(N). <br /> 3 CENTERSHOW LINNS IN FEET OF THE FOLLOWING: (A)E (C) BUILD NG(S)MEASUREMENTTOHE(ORDINARY HIGH TO ALL LOT WATER)MARK(OHWM OF LAKE, m v <br /> NE OF <br /> Z <br /> 0 <br /> STREAM OR RIVER. <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 I <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE g ° <br /> ISSUED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <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. <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 /> 13Da _ <br /> 6. wrao oro i <br /> Z : �o'i <br /> 7. = E M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m m M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- m <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 application. I agree to permit county officials charged with administering county ordinances or other ; m E i <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o <br /> (o <br /> SIGN HERE (date) <br /> naWre of own or building contractor) ( <br /> ZONING ADMINISTRATOR '^'�' <br /> •rNiicNno ,r PPP <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />