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nlewAp <br /> Burnett-County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. t <br /> r <br /> a ° � <br /> A / S � <br /> OWNER JC-FP"y A. L�oopCa C/< TELEPHONE e'/7 97Z lfyz m <br /> e O <br /> HOMEADDRESS Aebcand Alc-. F�/NA MN. rryi( <br /> r o <br /> � D 0 <br /> EMERGENCY/FIRE NUMBER Z 7£r0 7 ROAD NAME et-l-�Ale -Fey <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) 1 <br /> N <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE�YY ADDITION c 0= <br /> n <br /> 5. <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> N <br /> / 2 <br /> STRUCTURE/ADDITION USE: _'W469 6 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) q•g <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR ro 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> m Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S 'q <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 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. :E <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,� o <br /> t7 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE li ?, ) <br /> ISSUED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c 1 <br /> CONDITIONS OF PERMIT: <br /> 0- <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. Qyg pp>F <br /> 6. RA� nMN2A <br /> 7. oZi f w ,5 i <br /> E co: m <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 o.`� E <br /> all Information contained In this application(including any accompanying schedule)and I further declare that I recognize ' u e E E '• fn <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- <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 <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 des ribed premises at any reasonable time for the purpose of Inspection. T <br /> /1 TOE i <br /> SIGN HERE /p- <br /> (signature of owner orbuildingbuilhdingg contractor) (data) <br /> ZONING AD TOR �(n T 04)IGb1Clf04 1 I(/L�(1 a a a N M H <br /> N N N N N N N <br /> cel InON fn00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />