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� c�-� <br /> BurnetpCounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS It 3 4 <br /> r <br /> Lee <br /> 1� N 0 <br /> L <br /> OWNER ee A P.0 TELEPHONE g6(o — !� <br /> HOME ADDRESS e'l o j f `Q 0 <br /> EMERGENCY/FIRE NUMBER 1 7 S o <br /> ROAD NAME I C>0 <br /> LEGAL DESCRIPTION(see tax receipt) LoT f D AM DY1 ( W Al o /A101- p / __v� WT' i� -C 7� f <br /> �Y cT+ N <br /> o <br /> TYPE OF PERMIT(S): DWELLING/B �/UILDING GARAGE/ACCESSORY STRUCTURE ^ ADDITION C <br /> c <br /> c <br /> CL; <br /> SANITARY PRIVY S. <br /> FILLIINNG//GG+RADING/� � CAMPING UNIT SUBDIVISION <br /> W <br /> W r t ' —A <br /> STRUCTURE/ADDITION USE:. <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) '' 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3. <br /> DIRECTIONS FOR PLOT PLAN D WIN H <br /> (AERIAL OR TOP VIEW) C c <br /> m B. � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M If d <br /> NORTH(N). y ® �c <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 WATERMARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- 9 <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q 0 W <br /> ISSUED. q <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ^. <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITo <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 LA <br /> 5. KES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. <br /> X 0r oLo � <br /> 3 Ck m <br /> 7. o H CD : o,o i <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Cr. . : O <br /> � : m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E ` E C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CL <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- : m <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 applicati n. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to access to th ve described premises at any reasonable time for the purpose of Inspection. m <br /> m <br /> o : <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) . <br /> ZONING ADMINISTRATOR <br /> N N M N N N N <br /> ut NONPPR <br /> TOWNSHIP PERMITS MAY BE REQUIRED0 0 0 0 0 0 0 <br />