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Burnett Cqunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator vU G ' <br /> APPLICATION FOR LAND USE PERMITS s 4 <br /> iw r <br /> 0 <br /> OWNER J�,''f AM) e 76� / s'r&-7-Z1 � TELEPHONE Ie I2 /82- 75�7 v <br /> � d <br /> ji <br /> HOME ADDRESS q t)t)() 4'Lt(_ S"ff aC VI& yyl/t/ 1j Y7 2-1( <br /> r � <br /> EMERGENCY/FIRE NUMBER ROAD NAME FKJ�-?n <br /> f � <br /> LEGAL DESCRIPTION(see tax receipt) d a — 5a <br /> co <br /> TYPE OF PERMIT($):DWELLING/BUILDING—X—GARAGE/ACCESSORY STRUCTURE ADDITION C <br /> Crn <br /> w' <br /> SANITARY_PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> co <br /> STRUCTURE/ADDITION USE: FlIGLF 110kn,57- fi{ <br /> N <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) y <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) M <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m80 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. G P <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. Z <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 <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. <br /> O 9 W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> w p <br /> ISSUED. ((} <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o �--� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ( ' /I� <br /> ISSUANCE. y 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 /> 6. SOODC4<S <br /> 1 : w <br /> 7. Z ' '� <br /> o <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my t3 o ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all Information contained in this application(including any accompanying schedule)and 1 further declare that I recognize o m E E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y 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 E E <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 pre)niselfat any reasonable time for the purpose of Inspection. -n <br /> SIGN HERE <br /> (signature of;owner <br /> �orr builds ntractor) (date) <br /> ZONING ADMINISTRATOR tJ ifI 1 IfYI \IOI , <br /> 4040404440 <br /> Li <br /> N N fn N N <br /> N O ut N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 o c o 0 <br /> 0000000 <br /> ! DC-Ss°fl% <br />