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Burdett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> ,n O <br /> N <br /> C , <br /> _ ( � W <br /> OWNER �Q V^r u I�1 f C, �ti s TELEPHONE �� + 1657 o0 <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER x`73901 ROAD NAME L b.v.L 1,kA4j <br /> / ` <br /> LEGAL DESCRIPTION(see tax receipt) L' CSh� t �� ! 34- �I LG 0—/4 y <br /> M <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTUREADDITION— <br /> SANITARY— <br /> DDITION SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR -n 3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p rY <br /> � m O lig <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). U) <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, p <br /> Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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 /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS Oa ?. <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q ° Q <br /> ISSUED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o w <br /> CONDITIONS OF PERMIT: w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. v <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 4 <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 /> CL <br /> m � 3ELM <br /> 6. V N Cin y o 3 <br /> Z (^ ,p o �� <br /> 7. 0 . �A rn t1 <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G>c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of rv,�' v <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 f Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials if i i Lnty ordinances or other m <br /> authorized person to have access to the above described premis ti r174e purpose of inspection. n <br /> m <br /> Uj <br /> m <br /> SIGN HERE <br /> (sign re f wneror Ing contra ` 2� (date) <br /> 111: <br /> ZONING ADMINISTRATOR <br /> NTy �. PiM: LMM CA <br /> CA <br /> N N (n N CA <br /> QQNN���� Dcb0 u, 0 0 0 <br /> TOWNSHIP PERMITS MAY BE RE�IUri" I�Q <br /> g0000mo <br />