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Burnett County 7410 Co. Rd. K, No. 102, Siren,VVI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> CL <br /> N .� <br /> C <br /> _ N <br /> OWNER L7 E�� 0 (� V S TELEPHONE 3 ?-0— j6?-`f17 7 m <br /> HOME ADDRESS IVAI 5�3� o <br /> EMERGENCY/FIRE NUMBER ROAD NAME �p Lrr f SNp� w <br /> cn <br /> LEGAL DESCRIPTION(see tax receipt) <br /> o <br /> y 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION or <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> 0) <br /> p 7 <br /> STRUCTURE/ADDITION USE: 0 ,449 f'1V b S JI is <br /> (Home/Cabin; Co mercial Business; room; D ;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 00 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) co <br /> T G <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C .. c <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m ~ 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. 0 <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. I 0 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 2, <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o C 0- <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 F THE OHWM OF LAKES, <br /> P DS, RI�VERUNLESS SPECIFICALLY PER ED. <br /> p-� X 3 0 �M <br /> 6. 3 <br /> N <br /> No !�' 03m <br /> � '• ;a7. _y; E <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ? ZS Crt : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m 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 I ' is; 'm '• '• <br /> providing in this application. I agree to permit county officials charged with adm c o�I e r E m E E <br /> authorized person to have access to the above des d premises at any reasona I e l <br /> I m <br /> m <br /> h <br /> SIGN HEREOE <br /> (signal bu =con ) a e <br /> ZONING ADMINISTRATORH w 40. H <br /> j ONIIV^'G N uftN 0 N N N <br /> OOOO <br /> TO NSHIP PERMITS MAY BE REQUIR9D. <br /> � P/1 f <br />