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ct-ry� <br /> BurnettpCounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 < ° <br /> r <br /> N O <br /> N <br /> CL <br /> OWNER fbavt? ,- W Q(/td-Q -8atdon TELEPHONE 34-01-__79& d <br /> HOME ADDRESS (P Qlk� 1 ,� I/_ � �_ V <br /> amu.t�-e� r m <br /> EMERGENCY/FIRE NUMBER <br /> '5595 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt)L-0 e. [Q 1 -10 Z !�ec. ]� T'fONi isw m <br /> CD <br /> �jCno <br /> TYPE OF PERMIT(S): DWELLING/BUILDING--)�--GARAGE/ACCESSORY STRUCTURE ADDITION a ' <br /> c <br /> v <br /> Lit <br /> 5.N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> m <br /> STRUCTURE/ADDITION USE: � <br /> (Home/Cabin; Commercial Business; Bed oom; Deck;etc.) <br /> m <br /> PLOT PLAN MUST PROVIDED A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> I <br /> LLEGIBLE PLOT PLANS WILL BE RETT mURNED. l�riJ`h"//!` 0 <br /> M N C <br /> DIRECTIONS FOR PLOT PLAN DRAWIN (AERIAL OR TOP VIEW) p <br /> n n <br /> -n 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 <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. J 11 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. 1 N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q o <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. zo <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 /> W Oa m <br /> m <br /> 6. <br /> 7. Z : W 1 <br /> P =ijO <br /> y : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whetm <br /> her to is- O <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> CD <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> CD : <br /> (D <br /> SIGN HERE <br /> � : <br /> (si tu e of owner uIlding contractor) (date) <br /> ZONING ADMINISTRATOR V� , <br /> JOS U1 V7 N O ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />