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GZA CA-7 ti cr <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> C <br /> / <br /> G <br /> // <br /> OWNER ,J VA 6f, G �7 W 7 l Z TELEPHONE j CO / 2 e7 <br /> �(�67 /IrrLrrl'eT o o <br /> HOME ADDRESSe 7r <br /> h <br /> EMERGENCY/FIRE NUMBERZ /S ROAD NAME �1� C1 1/ <br /> A- <br /> LEGAL DESCRIPTION(see tax receipt) Z_ c-� P V �/rs/\� <br /> � <br /> sy 7 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE__)�_ADDITION n <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> q�- rn <br /> STRUCTURE/ADDITION USE: l]5rt Er <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) 'a <br /> I <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ^ <br /> ;a c V <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m ;a2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). co ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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. Q <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. U2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. ` W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75� OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. y <br /> 5. C' ro y� to be - lec�fi tO fit' �f a� /y CD ; ;r, o g o m <br /> '�t1 bye /.�( /eGc-51 'OV - �r'�r►,�t.G�. . / ' " a a o u) a= 3 <br /> Mq i NCPQ : : <br /> go <br /> Z : <br /> 6. <br /> 7. E 1998 : . <br /> .0 = rn: m <br /> I declare that this application (including any accompanying schedule) has been exams 1Wnu�o the t of my Gf c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsi� uracy of Z: a <br /> all information contained in this application(including any accompanying schedule)and I fu eclar6 that I recognize °CS m m <br /> that this information I a roviding will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> _2T m <br /> sue a permit. I further _pt <br /> all liability which may be a result of the County of Burnett relying on this information 1 am m <br /> providing in this appli a on. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to a access t e ab deppribed premises at any reasonable time for the purpose of inspection. T <br /> M : <br /> SIGN HERE <br /> S 1-3 qY' <br /> gnat a of own b ntractor) (date) <br /> ZONING ADMINISTRATOR <br /> ,Q�j v+ Fn to ri to En Cn <br /> V N NUi N NCn <br /> NUt0P <br /> Vt NOO <br /> O 00 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 00 0 0 0 <br />