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Burnetttounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITS . L <br /> r <br /> l a <br /> /6 �/O 3 C� <br /> OWNER G,�-fA 'k.GrzS T!�' TELEPHONE !`� Z -et'7_ "L- <br /> a <br /> m <br /> HOME ADDRESS C?,r GCJ, t_-p C7 $ <br /> ,} <br /> EMERGENCY/FIRE NUMBER 4-770 ROAD NAME ,Be!7e_71e1fx-1 i <br /> LEGAL DESCRIPTION(see tax receipt) i c <br /> �r�C /1 T%/1�f/L-� m <br /> N <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE DDITION <br /> v <br /> n <br /> 5. <br /> 0 <br /> SANITARY PRIW FILLING/GRADING CAMPING UNIT SUBDIVISION � <br /> A I� <br /> /T <br /> STRUCTURE/ADDITION USE: 001 T!oN.f-i-- -s a V <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) " 'r <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O EL v w <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 6 � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C — O <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <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 S <br /> MUST BE SIGNED AND DATED BY THE OWNER. n c <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. 4 c <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. e <br /> CONDITIONS OF PERMIT: <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 /> U '70g QGQ 09 <br /> a �Fa ;MQ6. it s c " 3 <br /> 7. Zw <br /> III : 7g <br /> P <br /> =H[ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myg E E r <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of '• m' E ; C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ' m'm E M <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- m E E [ p <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 ig E E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ! n E <br /> authorized person to ve access to the ascribed premises at any reasonable time for the purpose of inspection. T i <br /> SIGN HERE <br /> (signs tu�r1e.9,t owner or building contractor) (date) <br /> -Vi <br /> ZONING ADMINISTRATOR )rn Eon iaaI n • � '• W <br /> M MHHHN+ <br /> N N N N N{m U <br /> V7 V7 O H ut O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />