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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator V G) o <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> .. r <br /> OWNER �� L C S� ('� ��6�( /A/j5�51 j- p,;/7-/TELEPHONE 3 36-41 <br /> o <br /> m <br /> HOME ADDRESS ��y fj �� - 17`�t Jr Yn <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> r � <br /> LEGAL DESCRIPTION(see tax receipt) � � s g7 fL S� lw. t 11:7 Q/all,LA. Z I c <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION- <br /> ,9-CL <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT-SUBlDIIVIISSION0Cn <br /> ([� <br /> STRUCTURE/ADDITION USE: �-�P D Z T T U�l �1`�J �1L1G" (r1��;e�.v Er )Vnk. <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 3 <br /> In <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED, p <br /> X <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C O <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN 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. OO <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: Qrrr` <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. <br /> 5. <br /> $ a <br /> 6. v a v _ <br /> 7, o f FCD i <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m a <br /> sue a permit. I further accept all Ilabilky which may be a result of the County of Burnett relying on this Information I am m <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. . <br /> : <br /> Co i <br /> SIGN HERE — <br /> gi ture of owne Ilding contractor) <br /> ZONING ADMINIST OR v <br /> 4040404444w <br /> J0 (A0MCA00 <br /> TOWNSHIP PERMITS MAY BE REQUIRE <br />