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` 1 <br /> Burnett Copnty 7410 Co. Rd.K, No. 102, Siren,W164872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> /� w <br /> r <br /> OWNER �� W�Dl i� - Vt 3160 <br /> Roe s ef- V e L4 Q TELEPHONE l <br /> HOME ADDRESS �d O 7 7">�1 l D rN�� �� ) 57�/ r <br /> S�orf. /�! G , <br /> EMERGENCY/FIRE NUMBER a 8 7 k ROAD NAME UVJ Z/ Lai <br /> v8614vrpt acifi of Govtot/ <br /> LEGAL DESCRIPTION(see tax receipt) S i,117-4o i R J 4 W ►4GR£S 1i,� Gtr : Ma_&RAiz4e, I,Q <br /> �i <br /> GON / rn <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCfURE ADDITION C <br /> or <br /> ON <br /> S — C7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 ro <br /> STRUCTURE/ADDITION USE: 1-iom e- <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWINGi (AERIAL OR TOP VIEW) 0 <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 8 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <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, — 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. i <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. oQ <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. o <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. g I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ^. O <br /> CONDITIONS OF PERMIT: P <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 /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. y <br /> 5. / r_»i��fcR S�sxres $a (,rp �'7 75 <br /> t/M �L '�{ 0 <br /> ;0 ,00r-W v? vim <br /> It 6. mCwmo9m <br /> 7. <br /> =Cr <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my :` c :' E ': p <br /> knowledge and belief it Is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizezt� ' o m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- Xiv <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 <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 time for the purpose of inspection. <br /> mE <br /> SIGN HERE ? ._c(+pvv 97__ H <br /> (si a re o(owns or ilding contractor) I (date) <br /> ZONING ADMINISTRATOR <br /> H <br /> MIT <br /> N tANHbIH� <br /> 0 <br /> ' � i til tT O t7�fT 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUI 6't. _-- 0 0 0 0 0 0 0 <br />