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Bttrneti County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adrrl l Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> r <br /> N 0 <br /> N <br /> C <br /> fD <br /> OWNER �� � C/ TELEPHONE y 4�i <br /> 7 m <br /> HOME ADDRESS Q o S S1'r evL, YOP2� �° <br /> r m ` <br /> EMERGENCY/FIRE NUMBER V ROAD NAME L� / �� 1 0 <br /> 4(� <br /> LEGAL DESCRIPTION(see tax receipt) � /t / d/o ) 1 W r( ' f <br /> C r, Ar ►Lc07 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUREADDITION ' <br /> c <br /> v <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION w <br /> o' <br /> 1 <br /> STRUCTURE/ADDITION USE: -30 [L yo S�)"�G�,Q �-I�„•'�'Q � <br /> z <br /> (Name/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 �- <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0c <br /> n o <br /> T v <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS (NB)AND INDICATE m <br /> NORTH(N). c 0 <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 AND MEASUREMENT TO WETLAND AREAS. 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. �O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. co <br /> o (� <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE o <br /> ISSUED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT i o <br /> ISSUANCE, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` T✓ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY G <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 /> X -0 0 r�D O D 0 -0 <br /> M . 0 N M a E m <br /> 6. 0 � CL :E <br /> N C N N O <br /> 7. <br /> Z : m W O it0 =j <br /> X <br /> = y : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my6 g <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accurac of m c— c <br /> Y Q�; c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 <br /> m <br /> providing in this application. 1 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 /> CP <br /> CP <br /> SIGN HERE <br /> sign ure of owne bullding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> to <br /> N N N ) 01 W <br /> 01 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o O o O On <br />