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P e'e>w <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> C <br /> OWNER AGL*vL )., TELEPHONE <br /> HOME ADDRESS y 90 $� f*rt'0R)C <br /> 1� t7 7G / r m <br /> 0 <br /> I ^' <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) O) C- 7 ,p / (y chi s -�.z 3 j ca <br /> tnT7 PZdy 7-A(rA✓' oCn�- o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> c <br /> Cr <br /> n <br /> SANITARYFILLING/GRADING CAMPING UNIT SUBDIVISION 0 �• <br /> 1 <br /> Ca <br /> STRUCTURE/ADDITION USE: <br /> D Nlor— � <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) '{ <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 3 .[ <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) � a fvA` <br /> Z <br /> T " 1 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Wv M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, P�jZ <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. r, C'Ci o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- V t <br /> INGS, ROADS, LAKE, LOT LINES. I " <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. \ N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> _v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE '" °, <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> r\ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Sv <br /> ISSUANCE. NZ- (� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Z <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 /> r <br /> CDM. m m m <br /> 6. <br /> m �< `rai d <br /> N C <br /> 7. Zi <br /> O 1Z G <br /> rn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c 10 <br /> C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ` F <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> 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 m <br /> authorized person to h ve access to the above described premises at any reasonable time for the purpose of inspection. m <br /> SIGN HERE <br /> ature of owner or building c ctor) (date) {(j <br /> ZONING ADMINISTRATORJln T Ia71 JU�f� <br /> VtNN V7 f71 <br /> O N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />