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dtfraett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -V 0Z <br /> APPLICATION FOR LAND USE PERMITS ° <br /> OWNER ^ J� L4 r,6it) TELEPHONE,��_Dgg— <br /> � � V <br /> HOME ADDRESS �'®� C d J ✓� / ) 'rI6 r <br /> N v <br /> � r 1 <br /> EMERGENCY/FIRE NUMBER a O 17 ROAD NAME C Q A4 L Mi <br /> �1 <br /> C L DESCRIPTION(see tax receipt) V 3' _ : (2 / j I D <br /> �(.� �p X 7 <br /> TYPE OF PERMIT(S):DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE-49—ADDITION w <br /> c <br /> Cr <br /> CL <br /> 5. <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION 0' <br /> STRUCTURE/ADDITION USE: 0 10 <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 v <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �I <br /> _ ON <br /> DIRECTIONS FOR PLOT PLAN DAWIN . (AERIAL OR TOP VIEW) c <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m a <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO In v <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- o <br /> INGS, ROADS, LAKE, LOT LINES. r <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. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. g <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z '. <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 <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, RIVERSf^U(NrLeESeSnSi P <br /> 5 ®/' E FICALY PER TTE <br /> , � Y D /Ur 7" O _ <br /> A_, <br /> 6. A ( ^ / Cl �j� / / � vC>r- G�O -0 <br /> Pwm1.� lVaLl) �P, AjU�^�_ �ddJ UO�1 ' / !c(X��l^`ll✓L ,� n Q � <br /> 7. <br /> ca .'0 <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my g : ` In <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm ` C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize E C R E ? m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability may be a result of the County of Burnett relying on this information I am <br /> providing In this application. ag to mit county officials charged with administering county ordinances or other <br /> authorized person to ave a as t t bove described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> h N(RHH N� <br /> N Nfr�N NNfn <br /> N N gf7i V7OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />