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01 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -u o c <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ^ r <br /> w o <br /> c <br /> OWNERG'rJl�K eil f1L"9� TELEPHONE <br /> HOME ADDRESS G teas eel. /�d, �C� S T, $/C : O c ,`u s Al, 6_6i5>%- 0 <br /> 1?4 trcq F Q ddr ass 11 .ter. <br /> EMERGENCY/FIRE NUMBER 30 9q1 ROAD NAME T bD� La Kc Ar, <br /> LEGAL DESCRIPTION(see tax receipt)/#/ Is' 506 ( , /,7 //A �iS ki sWrss v� iq <br /> o <br /> c ' r <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—ADDITION— <br /> SANITARY- <br /> TRUCTURE ADDITION SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: &enejcs /,g fOY Afg,&-I ber/l gactr T <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) y <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 /> w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 c <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE c n <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m /V\)I .o <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. <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 'l <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c XJ <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <br /> ISSUANCE. I i <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. <br /> 5. � �A� TCl �E� � � 091 CCU,��—[r l <br /> Aver v�vv <br /> 6. oIt 0 <br /> c w >> E <br /> =� m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my ; c ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i Q` E <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ' p <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 Info n I am m <br /> providing in this application. I agree to permit county officials charged with administerin other E E <br /> authorized person to have access to the above described premises at any reawapwtl u e 41 ion. m <br /> SIGN HERE !d <br /> ($I atu of ow r building co tractor) Ap^t( <br /> 1 ' 1 <br /> ZONING ADMINISTRATOR . . . <br /> H40 fA� <br /> U��E.4TG aNu,NNN� <br /> R I Y . P O fJ�tl O O <br /> TOWNSHIP PERMITS MAY BE REQUIREQ Z( N'N'1�-�'' 0 0 0 0 0 0 0 <br />