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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o03 <br /> f <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> Q L <br /> OWNER J-:Ye effC-t=_.� ' 1 (,�-let•- TELEPHONE '}(Cj I(03S - 8904 <br /> HOMEADDRESS 13-1(D Con-n ' A R8 . A , VICR-59 Spooner W, 5A801 Z� <br /> EMERGENCY/FIRE NUMBER ROAD NAME aA)r�4t Lnt l ed,i YITh II <br /> IV U �Ot• � i <br /> LEGAL DESCRIPTION(see tax receipt) <br /> cn -ice♦-CJI <br /> TYPE OF PERMIT($: DWELLINGBUILDING GARAGE/ACCESSORY STRUCTURE-ADDITION- <br /> 0: <br /> TRUCTURE ADDITION Q <br /> \/// n <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> N <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. S :p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m - O <br /> NORTH(N). y -- 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (8)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 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- <br /> INGS, ROADS,LAKE, LOT LINES. `r w <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 I <br /> MUST BE SIGNED AND DATED BY THE OW �^ m' (JAI <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q °, <br /> ISSUED. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c O <br /> CONDITIONS OF PERMIT: Jc> <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT b <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J <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 /> A 'o o g <br /> Q F <br /> 6. <br /> 9•'� v Ceem 03 S � <br /> 7. of IQ* <br /> ' : M <br /> .N[ [ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n E <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- m 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 <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other m E <br /> authorized person have access to the above described premises at any reasonable time for the purpose of Inspection. v i <br /> SIGN HERE <br /> (signature of owner or building contractor) ! (date) i <br /> ZONING ADMINISTRATOR ' <br /> � '. � I, rT tTONtT00 <br /> TOWNSHIP PERMITS MAY BE REQUIR D <br /> _ e <br />