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Burnett county 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator Cf V o <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> w <br /> a <br /> c <br /> OWNER _VASE 50,0,6A B ERG TELEPHONE <br /> O <br /> m <br /> �J <br /> HOMEADDRESS 2O�Z.Z IQy`'f��EPAPA//QE'LL Gp(lf <br /> EMERGENCY/FIRE NUMBER r�0 / /Oy ROAD NAME4,tt �Ct �C n I lal I <br /> LEGAL DESCRIPTION(see tax receipt) 449/XON ,SSC, /!� .�Q��/s►�/ ,�T,3 ,f� iS� o+ <br /> R <br /> N j <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE- )< ADDITION--X— n <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING / pCAMPING UNIT �1/�SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: 1 iT& / �OI�CfA �iA�' a6F=- 6 <br /> (Home/Cabin; Com ercial Busines ,Bedroom;Deck;etc.) 'aq i <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 /> A � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) r $ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'A <br /> t t <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). fCB ., �I 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 1 v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <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. CSO'10 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I <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' <br /> o y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEo �i11 <br /> 5 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <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 /> 5. p> Q <br /> 6. <br /> 7. Zi <br /> A <br /> m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my g E ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(Including any accompanying schedule)and 1 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- w 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 <br /> providing In this application. 1 agree to permit county officials charged with administering county ordinances or other ! w E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. r <br /> SIGN HERE <br /> (signature <br /> ofof 6Wner <br /> roorlbuilding contractor) (date) <br /> ZONING ADMINISTRATOR CY) 'Y K�1 11G1��(l N N• N H <br /> N N N N r n <br /> N N V7 O <br /> O O O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />