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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N <br /> C <br /> OWNER ( G� ��� � TELE)PHOrN /2-06 <br /> QJ <br /> HOME ADDRESS gco/ e. <br /> 2 <br /> /L4 Al <br /> EMERGENCY/FIRE NUMBER �`� 3 l V ROAD NAME <br /> A+ 1I <br /> LEGAL DESCRIPTION(see tax receipt) Y� V 4 tVs� 3 '411401� I <br /> { D� N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—OK" <br /> ADDITION <br /> a <br /> y <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> STRUCTURE/ADDITION USE: Zbffijj�� 1 <br /> �'X <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> _ Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C) A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rn <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. 9 <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. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. (o o I <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a S <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: L'-N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 ��v1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 , F LAKES, <br /> POND/S, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> sI� e � Oil <br /> xs. 101(c �QaAriM l aCD0. <br /> - �9 <br /> 1 <br /> 7. URIVF 4 B /� o <br /> I declare that this application (including any accompanying schedule) has been examine [[��,fAfhe best of my cj c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for tal�rt�eccuracy of c C <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize CDm <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is t7 <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 m <br /> authorized person to have access to a above jesqrlbed premises at any reasonable time for the purpose of inspection. -ntD <br /> ; <br /> m : <br /> SIGN HERE <br /> (signat6re ofpivAer orb ding on tor) (date), <br /> ZONING ADMINISTRATOR <br /> to to w u+cri w <br /> N N(TNN (] U1 <br /> V1 (TOfT (7100 <br /> T NSHIP PERMITS MAY BE REQUIRED o 0 00 0 0 0 <br /> 0000000 <br />