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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI SU72 <br /> APPLICATIO Office of Zoning Administrator a a Z <br /> N FOR LAND USE PERMITS 4 ° <br /> ^' r <br /> OWNER C ur l �s �. c5 cl arm e r�y TELEPHONE B .. <br /> HOME ADDRESS , 53 6 <br /> EMERGENCY/FIRE NUMBER ROAD NAME [ <br /> LEGAL DESCRIPTION(see tax receipt) <br /> [(A uJ xTYPE OF PERMIT(S):DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ` /ADDITION c o <br /> c <br /> SANITARY PRIVY FILLING/GRADING 5. <br /> CAMPING UNIT SUBDIVISION c <br /> STRUCTURE/ADDITION USE: //}/✓Y�/f�cK <br /> (Home/Cabin; ommercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR v <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 G <br /> DIRECTIONS FOR P OT P nN DR618tiN^ (AERIAL OR TOP VIEW) M o <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 Z <br /> NORTH(N). m 'A <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, v <br /> STREAM OR RIVER. P <br /> 4. SHOW THE LOCATION OF THE WELL Z <br /> INGS,ROADS, LAKE, LOT LINES. 'SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- p <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. w <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 o �I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q 0 I <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Cr SiJ <br /> CONDITIONS OF PERMIT: Z <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT o N <br /> ISSUANCE. G <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY -C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, Q <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. rnA'y LU,d� yr 1 <br /> 6. 1h ►'�O--I- Ltsh dl'l C�1 " ao <br /> 3 ' aas� <br /> 7. Ca o <br /> Z : a m <br /> I declare that this application (including any accompany <br /> ing schedule) has been examined by me and to the best of my y. . . <br /> JD <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am resand m <br /> accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- L7 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I a m <br /> providing g P : a/ : 0 <br /> P 9 in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized pe on to have access to a above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> SIGN H <br /> ature of own building contractor) a_; <br /> (date) h� <br /> ZONING A INISTRATOR <br /> �NNaoo <br /> TOWNSHIP PERMITS MAY BE REQUIRED / cob 0 0 0 <br /> oo0 oo0 <br />