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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator VAI 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 4 ° <br /> 0 <br /> N 0.. ^ <br /> OWNER �r I C'.KS O TELEPHONE 7)5- &g'j- a3,29 � 1C <br /> _ p m <br /> HOME ADDRESS q`�Z O A K& �Ift�sb(2 E ����r La Ce. mr LS37 <br /> Cl' e <br /> EMERGENCY/FIRE NUMBER (,O l z-14�'S ` "1.4 7(, ROAD NAME f)I p�j�I qgU LA lcN <br /> LEGAL DESCRIPTION(see tax receipt) 5qc+I E W 2t TW fl 346 JR , [-7 i�C L C, r�� C <br /> �" r o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION- <br /> 06 <br /> DDITIONa 1 ` ' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION c <br /> STRUCTURE/ADDITION USE: � <br /> (Home/Cabin; eommercial Business; Bedroom;Deck;etc.) 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. To <br /> DIRECTIONS FOR PLOT PLAN DRAWIN • (AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m or <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 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. c <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. d <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 t <br /> o XJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 3 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° <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. p0 JN <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 /> m m Oita -0 <br /> 6. v C c <br /> 7. Z w 'Q <br /> =yE m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ID <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofn : : 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- m O <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable ti r_the purpose of Inspection. '• <br /> CD <br /> SIGN HERE `CJc- -� � <br /> (si atu of owners Ilding contractor) f (date) E <br /> ZONING ADMINISTRATOR <br /> . o0 <br /> TOWNSHIP PERMITS MAY BE REQUIRE 00 0 0 <br />