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Burnett County 7410 Co. Rd. K, No.102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> o <br /> OWNER FRAAJC I S TELEPHONE <br /> o� � La C r ` j� <br /> HOME ADDRESS (7tO — 3/9s3 LQ —e 1` V VritJCj l — <br /> � o <br /> EMERGENCY/FIRE NUMBER ROAD NAME ag <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> 0 <br /> Q <br /> o) <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION n ^- <br /> (5101 T <br /> SANITARY PRIVY FILLING/GRADING i CAMPING UNIT SUBDIVISION- <br /> 0) <br /> lyJoL �c ' � ��` 1r �STRUCTURE/ADDITION USE: JU ie <br /> IV\l <br /> Er <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.)/ <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRE IONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) <br /> Y n - z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. g b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <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. <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 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED; 2 <br /> Z <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 1 1 <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 S�IFICALLYPEF;MITTED. <br /> 5. © ov JC"heB6'� �f.�^0/-'44' NUBS ,boo �, /F�E�v Www' S A - 0 r. jQ0��o -0 <br /> 6. �`v �lLd'lliw't V C•r-`- 56 !a / S 5�L."L 0.`: a C`H° N Z : 0 so _ .111:9 X <br /> T : III <br /> cn ; : M <br /> M <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my c ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize (n m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (� v <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am B <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 the above described premises at any reasonable time for thepurposq of inspection. m <br /> m : <br /> SIGN HERE <br /> (sl tur of owner or build contractor) (date) <br /> Q <br /> ZONING ADMINISTRATOR <br /> All <br /> tAHNN (A <br /> N N w N N <br /> rll N O Vt O <br /> O O O O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 <br />