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60 <br /> ,odmett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 i <br /> Office of Zoning Administrator v <br /> APPLICATION FOR LAND USE PERMITS _ 4 ° <br /> r <br /> N w <br /> OWNER n <br /> /"A V TELEPHONE 0 <br /> m <br /> HOME ADDRESS3 3 7 C 0 _ �J O <br /> f� <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> Ti�o�r!'s o iu SPA <br /> to) <br /> LEGAL DESCRIPTION(see tax receipt) 2" O— — s-O DTYPE OF PERMIT(S); DWELLING/BUILDINGo <br /> GARAGE/ACCESSORY STRUCTURE DDITION <br /> CLcr <br /> _n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT 5. <br /> SUBDIVISION o' <br /> STRUCTURE/ADDITION USE: bia. <br /> (Home/Cabin; Commercial Business; Bedroom;Dedc;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR C 1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T _ <br /> DIRECTIONS FOR PLOT PLAN DAWINGm (AERIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE a z <br /> NORTH(N). m S <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m �aj v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OH OF LAKE, I <br /> STREAM OR RIVER. z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- c <br /> 5. INDICATE TIFF ROADS, LAKE, <br /> BA 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. <br /> m o Q1- <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. T <br /> CONDITION OF P RMIT: z <br /> 0 <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 SPECIFIC LY PE MITTED. <br /> 5. SIhU' "'c l�� Af 1c%Eas /� � �am �rtu.sr��ra $T:f- �vrn Sv `Tq+'k-, <br /> 6. - m r (3 D 'a <br /> 7. � 3 Ca g a m <br /> No <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my a co A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m i <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i ': <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o ' <br /> m : <br /> SIGN HERE o <br /> (s n re of owner or ullding contractor) I( ;` (.;.i' U date},., ' <br /> ZONING ADMINISTRATOR ! �A; <br /> � � I ' N INJ10N NOO <br /> TOWNSHIP PERMITS MAY BE REQ <br /> 0000000 <br /> f� <br />