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Burnett Copnty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminiratsf or v 0 z <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> '. 0 �y <br /> OWNER <br /> J C <br /> AD I Q /�'/ (7_0 <br /> 8'<11 <br /> ( Y � M u e � -e j- TELEPHONE r Z'�6 3O T 7 <br /> m <br /> HOME ADDRESS E- /S f N (/j Q J 0 N ^I S <br /> O/+ N (u N I w (� <br /> EMERGENCY/FIRE NUMBER 9 O ROAD NAME CCc a <br /> AC C4. it 140 1 ISO. It , 0 L 1UW SC TTW SE 1 <br /> LEGAL DESCRIPTION(see tax receipt) 0 a 0 — / / — ^O Q <br /> / d fA <br /> TYPE OF PERMIT(S):DWELLING/BUILDINGGARAGE/ACCESSORY 03 <br /> STRUCTURE ADDITION ) c 3 <br /> _n !� <br /> SANITARY PRIVY FILLING/GRADINGS. <br /> CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: ca <br /> 14y" / /s =0 <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. _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. In <br /> In o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m or <br /> NORTH(N). C n <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, p <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- ) o <br /> INGS, ROADS, LAKE, LOT LINES. fl. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. SCJ <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. vl <br /> CAO 0 <br /> o o Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a <br /> ISSUED. <br /> LU <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITION OF PERMIT: <br /> c <br /> . l <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. 1 <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, 4Z <br /> 5. PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. ATo0, m pv�ov <br /> 3 'a �Ea <br /> 7. 9 ' vcywo's3 <br /> " (ODz 'IPS <br /> I declare that this application (including any accompanying schedule) has been examined by me and to thebest of my — co <br /> m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Rj ' �` ' A <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 upon by the County of Burnett WistoPsUr .getermining whether to is- E G3 <br /> sue a permit. I further accept all liability which may be a result of the C m <br /> providing in this application. I agree to permit county officials, mp is f ng m�this Information 1 am , <br /> authorized �� ,ty ordinances or other `• ` m ; <br /> person to have access to the above described pro lses�ata fal§t me for th urpose of inspection. <br /> SIGN HERE a!'( 199 v Iggr e <br /> h. <br /> (-s-ig—nature of owner or ullding contractor (date) <br /> ZONING ADMINISTRATOR }� rcou (��� . <br /> �t`✓" ►�ry� �7w <br /> TOWNSHIP PERMITS MAY BE REQUIRED N w00wo w0 <br /> 000: : N wv:, <br />