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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ r <br /> y O <br /> � N <br /> OWNER (`•-1 riN� �C11C�I lU �"I— "� o <br /> TELEPHONE c <br /> HOME ADDRESS oti��3'J {�marK �. `�rdnlwrG) W� jjj z <br /> m <br /> EMERGENCY/FIRE NUMBER ROAD NAME IS lye'y- tQ <br /> LEGAL DESCRIPTION(see tax receipt) �_t� 3 't ? I m <br /> J O <br /> a <br /> y o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION ' <br /> v <br /> n <br /> 41 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT1 SUBDIVISION___,k <br /> STRUCTURE/ADDITION USE: <br /> C � � A(o � I137-144y <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> TO <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m OO v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 90 <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEa <br /> ISSUED. C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J(J <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 /> X -V 0 0 0 -0 <br /> 6. 03nNN2- <br /> a = 3 <br /> � N C N O O _ <br /> 7. z : `° G _meq <br /> o . <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ID <br /> C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of i <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 4 m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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. 1 agree to permit county officials charged with administering county ordinances or other m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ,� <br /> - : <br /> m : <br /> SIGN HERE <br /> (signature <br /> �of�owner or building contractor) (date) <br /> ZONING ADMINISTRATOR �J ImI�II�1�� to <br /> �4049461)494� <br /> N N (n N Nfl1 Ut <br /> O 0 01 O 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o <br />