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on ov)4 . <br /> Burgett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -u o° o <br /> APPLICATION FOR LAND USE PERMITS o <br /> OWNER TELEPHONE <br /> d <br /> 1 y� it <br /> HOME ADDRESS 6 DLl l 1JQ.C/r� D.� L PTS �V�S `l—L�g r0 1 <br /> EMERGENCY/FIRE NUMBER �D`T� ROAD NAME <br /> r T <br /> LEGAL DESCRIPTION(see tax receipt) �� 4 O—S m U6 5 4 f 0 c?j --3`/ ��_ C <br /> In0 <br /> N o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION a o <br /> a. h <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 r �� <br /> V1 <br /> STRUCTURE/ADDITION USE: �.� A1C XPi '4 P j>'CEZ7Z,h� t IXa �A or <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 rn <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> M F. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'ro <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C C) <br /> NORTH 3. SHOW DIMENSIONSIN 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. ° <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. 64I , <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. v 6 <br /> SU <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr ° lJ <br /> ISSUED. T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1 <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> POnND�S,'RIVER UNLESS SPECIFICALLY PERMITTED. 1 // /�,, <br /> 5. �1 �f�c>ti A;,) f `fib Q yC eej 65 ' Sa ck- A3 e ST_,Uj I4 I&I Apt, ;0 ,00 r- o�o -0 <br /> i487 urr�¢ �t 13o�g a M <br /> s. <br /> v C w CO. = 3 <br /> 7. c H 0 'o ff <br /> y; : x <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my + c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? o E E C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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 E E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ; co <br /> authorized person to have access to the above de ribed premises at any reasonable time for the purpose of inspection. T <br /> e : <br /> e : <br /> SIGN HERE <br /> (sig lure f�ownor d g eonVactor) (date) <br /> ZONING ADMINISTRATOR <br /> GCS 'A'A N fe 41"H <br /> N N m N N O m <br /> N OIOfT VtOO <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />