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ejt <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator L�9/ G) Z <br /> APPLICATION FOR LAND USE PERMITS 4 P <br /> J <br /> OWNER E'A�t^,C,�. TELEPHONE a <br /> HOME ADDRESS � � �oF'i i S{ero2Ia � � <br /> c � tb � <br /> 7 4 Y3d <br /> 300 <br /> EMERGENCY/FIRE NUMBER d T'� ROAD NAME QDI rS <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) ' / ! 4 1 - �' t <br /> in <br /> d <br /> TYPE OF PERMIT(S): DWELLINGBUILDING GARAGE/ACCESSORY STRUCTURE ADDITION k� ur ' �¢ <br /> c <br /> a <br /> 5. <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o� <br /> STRUCTURE/ADDITION USE: IJf'C,IG- Ig <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. or -- <br /> fi � <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) Rn $ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m $ <br /> NORTH(N). WWC O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO fn <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, v 1 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. 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. <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q $ <br /> ISSUED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <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 SPECIFICALLY PERMITTED. <br /> 5. <br /> ;0 � Oy FOV <br /> 6. � ' c�" n' § m <br /> 7. Z � a �Z A <br /> P <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ? $ ` ` ID <br /> m <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 I further declare that I recognize r,, 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 m' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other I <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> SIGN HERE— �'-cov✓. Y/� Q.6 y. . E <br /> (sign fownaforbuilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> a <br /> NMN N� <br /> N N N tT tr <br /> trUO OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 <br />