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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> NO <br /> N <br /> C <br /> _ a � <br /> OWNER /LL � TELEPHONE/s) B Jrr�y <br /> ✓/ � C`ori\i <br /> HOMEADDRESS242 <br /> 0 <br /> EMERGENCY/FIRE NUMBER .'7yl y ROAD NAME,5,4,10 <br /> LEGAL DESCRIPTIONsee tax receipt) �/ — \ <br /> ( p)C�J. �07 � A).a��a�t /SCn <br /> �c�rite�f (aic v <br /> CD0 <br /> CO <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE 10 ADDITION C <br /> rr Z71 <br /> a n1 <br /> W w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> co <br /> STRUCTURE/ADDITION USE: RX/CP cs76teK she Q' V <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 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O `m <br /> T o. <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;? i <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 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 pz <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. XJ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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 <br /> o � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 <br /> ?✓ <br /> ISSUED. r <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 /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 11� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 7¢_ WM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. (j�} <br /> 5. <br /> M n r OO <br /> D <br /> a V <br /> 6. VCR[ 0 3 CL M ;a <br /> N C H y > <br /> 7. MAY 2 off, 6 1998 oz : <br /> : <br /> — cn <br /> I declare that this application (including any accompanying schedule) has been ehOmm to the be t'01 my <br /> �� C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsiblej��I�e �}�curacy of m <br /> all information contained in this application(including any accompanying schedule)and I fttrtF{Hf 4ere tha't1 recognize <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 <br /> providing in this application. 1 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. <br /> m : <br /> SIGN HERE <br /> natu o caner or builds ntractor) date) <br /> ZONING ADMINISTRATOR 1 �, <br /> M NfT M M (n (T <br /> U1 UtO [T OOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />