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OX60y7lp <br /> r <br /> Burnett Cpunty 7410 Co. Rd. K, No.'102, Siren,WI 54872 Office of Zoning Administrator - o° c <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> �IJAIUAf �FCayOWNER bTELEPHONE -� gl <br /> HOME ADDRESS ��() , �a �( �, Z (P14A i if 4.4! r/.Z' !l9 V6 l <br /> r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME SO, 4.'' 79 4kA <br /> j R64t ) <br /> O <br /> 3<<<37 • 5'7/l S 4(T3 700 n <br /> rA <br /> LEGAL DESCRIPTION(see tax receipt) C, T3_1g/fj�✓�o S�C O PC L_ E C rvl _i/.3 <br /> (IN G,V To-r Y 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-10<—GARAGE/ACCESSORY STRUCTURE ADDITION— <br /> TYPE (I <br /> 5. <br /> �. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION � <br /> ur <br /> STRUCTURE/ADDITION USE: <br /> CAb �I-1 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ' <br /> it <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> M m lJJ <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) n ii <br /> D <br /> �t v 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 c <br /> NORTH(N). (/� v <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S)TO m o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> o <br /> STREAM OR RIVER. <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. _C� 6' 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEcr <br /> ISSUED. <br /> Z O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. (h <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ryO <br /> ISSUANCE. �1 <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 LA <br /> PONDS,RIVER UNLESS SPEC FICALLY PER ITTED <br /> 5. i{/n Q <br /> ;0110m agov <br /> �/f(f fUi yX� �,� �jy p't 3 a �ft% <br /> 6. m o i m <br /> 7. O�Dd�. a vii <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my f ZS C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize m <br /> f� i O <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �: m . <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 /> authorized person to have access to the abave desclilbed premises at any reasonable time for the purpose of inspection. -n ; <br /> 0 <br /> SIGN HERE <br /> (signaturo ow ror Idin ntn � ' ' (date) I <br /> ZONING ADMINISTRATOR `^d'�^ <br /> t N NNNNtn p� <br /> j ; V t f l O N I n 0 0 <br /> 6 0 0 0 0 0 0 <br /> TOWNS IP PERMITS MAY BE REQUIRED i` <br />