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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator V u 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> 0 <br /> w o <br /> r c l <br /> OWNER rGitf/�/CAC Q40C TELEPHONE fr�'(p J C — �Oj d <br /> _ o <br /> HOME ADDRESS �oT9d �,� 77 ND. �I AN��/2 w� '--7/c, 0 <br /> 30 <br /> EMERGENCY/FIRE NUMBER ROAD NAME �j^,Qp`,O <br /> LEGAL DESCRIPTION(see tax receipt) <br /> Lcr /� \ <br /> r ► CSrn V. q p. aal �E-)00 <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION Co <br /> or <br /> 06 <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> a, <br /> STRUCTURE/ADDITION USE: a rc"1� ��L�(� <br /> 6 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) " <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> Ju m <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0 m <br /> -n n <br /> " Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m i3 <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 fyn 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 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. <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. 5 c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. W <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. <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. Li ;M0 <br /> 7. Z w Z Baa i <br /> o E <br /> y: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ' p <br /> knowledge and belief It is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy ofCL <br /> w C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this Information I am providing will be relied uponby the f Burnett Wisconsin in determining whether to is- m p <br /> sue a permit. I further accept all liability which may be a re to, <br /> of the of Burnett relying on this information I amproviding in this applic nagree to permit county o cials charge�unty <br /> th administering county ordinances or other mauthorized person to c ss to the above descri premisesata asonable time for the purpose of inspection. m <br /> m <br /> SIGN HERE `Y" ' <br /> (signature of own r building co tract r) (date) <br /> ZONING ADMINISTRATOR V 1 S <br /> 40 40 <br /> N NCnNN (T(n <br /> N N O N O O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 o <br />