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071 eon <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator 0 0 0 <br /> APPLICATION FOR LAND USE PERMITS , <1 Q` <br /> OWNER h ;n 1 / V7 Ga TELEPHONE / �= <br /> -79e% 30NIA �./alb I.17/ •aaLti:.:_si.. eli-I fi 7 D"r% kc,. LntAc- S <br /> HOME ADDRESS <br /> EMERGENCY/FIRENUMBER /'q .7 ROAD NAME LJunAph, Le&ke& ve <br /> I r <br /> LEGAL DESCRIPTION(see tax receipt) 1 C IM U I I (2- `1a1�I I`t' i y <br /> 0 ra <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE_ ADDITION e <br /> v <br /> Q. <br /> SANITARY PRIW FILLING/GRADING CAMPING UNIT SUBDIVISION 0 � <br /> y <br /> STRUCTURE/ADDITION USE: �/� 1'� �' t n„ L� a�4` •ter �--1'I('.�,J r r <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING. (AERIAL OR TOP VIEW) 0 � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. G z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m IF <br /> NORTH(N). c O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M 0 30 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, C,o Z <br /> STREAM OR RIVER. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o 1 <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a g <br /> ISSUED. o <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 l <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. w�aT7 <br /> 6. L j f---fa be- Loc-a -pe/ mv are,G0j Pe^ (( / 8.' a a w 442: % <br /> w . <br /> 7. <br /> o .� <br /> _ur; m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (.1 9 '. ; p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognize i m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ? p <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 d <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. m f <br /> m <br /> SIGN HERE ' rh)LT <br /> r ? �^ <br /> gnatu of owns b ng contractor) r jd,ae) <br /> ZONING ADMINISTRATOR '• <br /> fA M N!A VI iN`+ <br /> N "MN N 0 0 <br /> ' UI NON NOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />