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IeA carnD <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v o 0 <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> 0 <br /> OWNER T m U h A. S k u n e 5 TELEPHONE I a - y - `f 36Ir <br /> HOME ADDRESS (9 QV jQ <br /> n co LCR- t M e0( 11 N�� / S5-1 IS OIS <br /> r <br /> EMERGENCY/FIRE NUMBER (? ROAD NAME <br /> e <br /> LEGAL DESCRIPTION(see tax receipt) 9� 0) <br /> a <br /> Cl) o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> v <br /> a <br /> S. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> Cn <br /> STRUCTURE/ADDITION USE: E f1 1 (2 w A <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) -{ <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. -n C <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING? (AERIAL OR TOP VIEW) p c <br /> m <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ?a <br /> NORTH(N). C Ti n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO mv 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. c <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. SU <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. c <br /> o W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <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. �y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V <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 /> 6. <br /> L <br /> . m <br /> R C w w a <br /> _v, m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cq p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm ` '• C <br /> all information contained In this application(Including any accompanying schedule)and I further declare that I recognize R m <br /> that this information 1 am providing will be relied upon by the County of Bumett Wisconsin in determining whether to is- m p <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Info rnatlon 1 am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other a <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> SIGN HERE %!�w'»v�y t7lJL <br /> (signalt <br /> m of ownerorbuilding contractor) (date) <br /> ZONING ADMINISTRATOR ` 1 ►m 7 , /1 N <br /> W N/w <br /> N N Ch Ln M <br /> (J1 CII O UI V, O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />