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Burn *County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> r <br /> CL <br /> N � <br /> OWNER TELEPHONE 71 j'- 4lGe 7 f�Y v <br /> /l� ��i� 'f�6��L!4 f�`�'�I.t m <br /> HOME ADDRESS ,irA' ,#- GUG T <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> s07/ 7"V0/ /j 4.cP ":L `yfd" /Sl_ 7 ' @ vr7Lp <br /> LEGAL DESCRIPTION(see tax receipt) Z —/ C'S/ys ✓ S P _6y 4 G iJ ✓ LOT 9� <br /> I o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> 5. �S <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION \ v <br /> Cn <br /> STRUCTURE/ADDITION USE: �'���'`✓� Y <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) 'a n <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O — O <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> O o C Z `5 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m Ll '.o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C O <br /> NORTH(N). W C <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, 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. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. v 6 I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE _q <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o V <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �1 <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. Q� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, �C <br /> PONDS, RIVER UNLESS SPP IFICALLY PER_[J_ITTE0. // <br /> 5. %, fs c� ///�f /'$ /O i[ /� QC7�ve �e ]) �p m m o o <br /> 6. e CQ f Q� lea/QCerrr ten. / to 3 n Q <br /> pre v,f e srd S.�— Alb � (/a fi� 6�t er � / � . v <br /> wHo =moi <br /> ? <br /> ' 1� E <br /> 7. _ <br /> - y: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zi 2 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ) o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m '. m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- '• v <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 V m <br /> authorized person to have access to ve described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> m : <br /> SIGN H <br /> Ia <br /> (signature of owne r wilding c frac r) / <br /> ZONING ADMINISTRATOR <br /> H NN V I 01 01 <br /> N N (/iNN tJt Vt <br /> P NO fll (Ji000060 <br /> 00 <br /> TOWN IP PERMITS MAY BE REQUIRED c <br />