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Burnett Codhty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v a o <br /> APPLICATION FOR LAND USE PERMITS . 0 <br /> N 0 <br /> N <br /> ty S-y c <br /> OWNERTELEPHONE <br /> }Eve rye ���� C v <br /> y� '\ —7�`� \nI g� O <br /> HOME ADDR 'J' 4 , 1 TUB �I l lJ t��YIE V `� i `� W o <br /> I1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME �`le•p((�) 4ot I ak I <br /> LEGAL DESCRIPTION(see tax receipt) L_L7t 1 CjTvi.fbrn 0. I i j c <br /> a <br /> y o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION or <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION � <br /> m <br /> � <br /> STRUCTURE/ADDITION USE: waIliN� � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T $ <br /> 11 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m $ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE Mc <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO In v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 1 Z <br /> STREAM OR RIVER. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- qu <br /> INGS,ROADS,LAKE, LOT LINES. X_ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N I <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. ° <br /> Uj <br /> o r' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr ° v l <br /> ISSUED. <br /> I, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. p <br /> CONDITIONS OF PERMIT: • 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <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. p <br /> 5. A ° 3a L <br /> 6. DC,NpNo = 3 <br /> o i w CQ ' ? <br /> 7. <br /> =vs: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my E 3 C2, <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a Er C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 'o ° m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determinin wh o is- <br /> 0 <br /> sue a permit. I further accept all (lability which may be a result of the County ^ t fs�irb�i R Lam ? m <br /> providing in this application. I agree to permit county officials charged with i g n s her E m ? E <br /> authorized person to have access to the above described premises at any reaso I o o t on. <br /> SIGN HERE P19 ✓ <br /> (signature of owner or building contractor) (dale) - <br /> ZONING ADMINISTRATOR i I3URNETT COUNTY <br /> ZONING N o N o <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 o f <br /> IMC s5� y- <br />