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Burne+t CoulZty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 c) Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER /�/� `� t?NH efr TELEPHONE �!�-�7`7���Q <br /> �h�0 21b Z, �l� Seo <br /> HOME ADDRESS �� � 0/'Y!P.YS� 0 <br /> _ / � 0 <br /> EMERGENCY/FIRE NUMBER �i �� ROAD NAME 6Ui- 5 Ir-4/` 1 1` <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) //a/�.� $E l4� ofSec `T"Twn/s[,Rp �N o/rghte 45W8u 9e (r <br /> m <br /> —T C o. Lo <br /> 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE-ADDITION- <br /> SANITARY- <br /> TRUCTURE ADDITION SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 (� <br /> N <br /> m <br /> STRUCTURE/ADDITION USE: G/GL .*7 E ` <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) a '( <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> ?r O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH (N). to 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, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Ll P <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- O <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS XJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0v04 <br /> I <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. 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 �J <br /> PERMITTED. r� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. 1 <br /> 5. <br /> M W 00 m o f M <br /> 6. m � � aMN <br /> " o �' 3 <br /> a m C m . <br /> Z <br /> 7. P ' <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 A <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of a C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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. I agree to permit county officials charged iy' t�Lrtiri�teTF •cor other E m <br /> authorized person to have ac ess to he above described premises at any ti tit o ' ection. T <br /> SIGN HERE u E <br /> (sig ture owner or uildingso_ntracr JUN (date) <br /> bu <br /> ZONING ADMINISTRATOR /Yl ���((// c3p ' <br /> cp yr to ui cn�' <br /> N N� NN (li Ut <br /> ZONING000000 0 0 0 0 0 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0 <br />