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Bumetj County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 0 Z <br /> APPLICATION FOR LAND USE PERMITS lit 4 <br /> a -°• 0 <br /> p c <br /> OWNER )7�,,J )PO L d c k TELEPHONE Gas <br /> 03 <br /> HOME ADDRESS a`.3oZoZ SES 1 <!i''sG T7, /a'O o <br /> EMERGENCY/FIRE NUMBER a 6,3 ROAD NAME <br /> w ��PSErr cx Ro -w <br /> LEGAL DESCRIPTION(see tax receipt) "71 � 1'0 <br /> � <br /> n <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE � ADDITION CA <br /> C ' <br /> c <br /> CT <br /> CL <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION w <br /> ca 1 <br /> STRUCTURE/ADDITION USE:_'94660 P x I o <br /> fir <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) -� <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) p � <br /> -n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T <br /> m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C n <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, . <br /> STREAM OR RIVER. z <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. N <br /> L <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 I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q ?, <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: /V <br /> DID 0A <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <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. <br /> X -00r-pR p0p 0 .0 <br /> 6. )off 3 n ie 3c a % <br /> Q L it N Q : =fG <br /> �irl/UCJ(l l/yr0 G`� a"M✓J �—_�to: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zj c : p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m' C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m ? m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 ; (0 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> - i <br /> SIGN HERE fi j i <br /> gn ure of owner b Ing contractor) (date) <br /> ZONING ADMINISTRATOR / 1 w <br /> NNNoaPoo <br /> TOWNSHIP PERMITS MAY BE REQUIR 0 0 0 0 0 0 0 <br /> 0000000 <br />