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B&frnetfvbtmty 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator $ 0 r 7 �z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> w T <br /> OWNER JJ I(BGG Ld/i Jc /A UL/ TELEPHONE <br /> HOME ADDRESS <br /> r <br /> EMERGENCY/FIRE NUMBER },(�/ ��,/ ROAD NAME I . n I'�juh /` ~ <br /> _ r <br /> LEGAL DESCRIPTION(see tax receipt) /3f a� � 1/0 16 4/ gyg <br /> Oy M O <br /> m � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING--X—GARAGE/ACCESSORY STRUCTURE ADDITION ii <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> uJ <br /> STRUCTURE/ADDITION USE: (4,4 4 n FwA 41 <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. 00 a <br /> rv) <br /> w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 $ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m g jo <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <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, c <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. LU <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS i <br /> MUST BE SIGNED AND DATED BY THE OWNER. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE E <br /> ISSUED. Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �'p- <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. YJ 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, UJ <br /> PPOfiNDS, RIVER UNLESS SPECIFICALLY PERMITTED. G <br /> 5. <br /> 1121 03 Mm <br /> 6. � 'got <br /> : 053 <br /> w ami <br /> 7. <br /> o € € �_ <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ? C <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of to o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ; t7 <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E m E <br /> authorized person to have acres h b e described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> n <br /> SIGN HERE <br /> gna re o nor or building con r) (date) <br /> ZONING ADMINISTRATOR <br /> N N Vf N N(T N <br /> N VtO Vt VtOO <br /> T111SHIP PERMITS MAY BE REQUIRED <br />