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O-yq cal-1p) <br /> Burnett County--7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 C) Z <br /> ' APPLICATION FOR LAND USE PERMITS 3 <br /> w <br /> c CY <br /> OVVNER Q (� ( -�(/� TELEPHONE <br /> HOME ADDRESS <br /> "( � �U o <br /> /� <br /> r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME �r �Or j 1� <br /> SJI <br /> LEGAL DESCRIPTION(see tax receipt) 3 CSM v. as CA <br /> a <br /> y o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE /+DDITION c <br /> 5. <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> � ay � <br /> STRUCTURE/ADDITION USE: fir <br /> i <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR UI/ 1 O 3 ' <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ©NS ow v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) r , �� ')' y adv[ p 'n o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. $� ! ^� ` <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICAT Mor <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M 9 <br /> a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. 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. 7' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 <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 -QLJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q 0 r,i <br /> ISSUED. W� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o y <br /> CONDITIONS OF PERMIT: C3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I I <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 SPECIFICALLY PERMITTED. ��t�lyi <br /> 5. PP,.+70 �/�r 7z� e-)ece-�d " �Cc A ��� a <br /> V p 'Vo0, d o�o � <br /> 6. a m <br /> N i LP wwo3 E <br /> -_Vl; rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c Io <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 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 ap aUon. I agree to permit cou officials charged with administering county ordinances or other m E <br /> authorized perso o h ve acceAs tqthe ab9V#descjFbecI premises at any reasonable time for the purpose of inspection. <br /> m <br /> m : <br /> SIGN HERE ri <br /> sign re of o r building contractor) �_z ••;+;:191_i1__�.-__.,.._ ;' <br /> ZONING ADMINISTRATOR <br /> OCT — 61997 n N cn S <br /> N NutNNN Vt <br /> 01 tT0(71 t7�00 <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 1 0 0 0 0 0 0 <br />