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Burnett touoty 7410 Co. Rd.K, No. 102,Siren,WI 64872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> a O <br /> c <br /> OWNERti G S G✓ TELEPHONE 0 <br /> m <br /> HOME ADDRESS �� p O <br /> �/ �/Yn,�1.•� � <br /> r <br /> EMERGENCY/FIRE NUMBER a ROAD NAME Or yfitluc,n Ft - <br /> 6c:11 kow Tw. J <br /> LEGAL DESCRIPTION(see tax receipt)lj} 3 S aZ ! T 1/6 4/ k) /6 tv 6XA tJe/ 6 vyCA <br /> v. <br /> fA <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION-_>L_ <br /> CL <br /> S. <br /> M. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: Lc / /Tdi/l� G/f� /(;,/f d/4)f re'y lIr <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> v (n <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> T CL <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 <br /> NORTH(N). -1b 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rt o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, pa 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. ,c c <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEq 0 <br /> ISSUED. S1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT U) <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. /nAX HA D�'F ;SU,/Wn A b e 35� z -0 0 r a s <br /> A l� f�� �) / �7 �✓ I 7. m = QD 2 1 m <br /> 6. �' cid L7r - U� 1� oti voX U.. � FaL�e � ttXS V .� 3nto '�Ea .'0 <br /> V » ! g! C w : 0 S <br /> 7. Zi Faq imi <br /> o <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my c i i C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have accessjq th v s'ribed premises at any reasonable time for the purpose of inspection. T <br /> SIGN HERE <br /> m <br /> re (wnerorbuildl co�ntrayc�tor)� (date) <br /> ZONING ADMINISTRATOR <br /> h H fA(A L"M <br /> N N N N rn <br /> Lti ONfn 00 P <br /> 9WNSHIP PERMITS MAY BE REQUIRED <br /> X0000000 <br />