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On (t)-ile <br /> BurnLtt County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator a 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> a <br /> 0 )t/ <br /> ` w <br /> OWNER C,G f 1,k TELEPHONE _iy I o <br /> HOME ADDRESS3 17-o Al <br /> n /,1 [ m <br /> EMERGENCY/FIRS NUMBER r4 D ✓ �� ROAD NAME k1k <br /> ,/yam <br /> (PS /v1 v� 9 I X� fX <br /> LEGAL DESCRIPTION(see tax receipt) li'v � `cf_ Q_ _ _� <br /> o <br /> N � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION (/ <br /> a <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <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 ar <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, c <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. :E 9j <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> l7 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 3 ° ) <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. IGI <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 /> x - mm oov <br /> � a <br /> rn <br /> 6. v C�^ ic <br /> 7. <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Cj <br /> C <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize M <br /> M <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- m t7 <br /> sue a permit. I further ccept all(lability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this ap itarG T3gree to permit county officials charged with administering county ordinances or other ; m <br /> authorized person 6 ve access to the above remises at any reasonable time for the purpose of Inspection. m <br /> r � ig <br /> SIGN HERE <br /> (s g a��re 'F', er or building contractor) (date) <br /> ZONING ADIISTRATOR D n anvi;4n . . ` . . . w <br /> MNHNN <br /> N ,p ONp OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 800000 <br />