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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 64872 Office of Zoning Administrator - l 0 0 <br /> APPLICATION FOR LAND USE PERMITS w o 0 <br /> OWNER VQ �K lI JO les TELEPHONE .3 m <br /> / -7 /� <br /> HOME ADDRESS �/U/ 13 S (1 i 2 wa Fa/Is, t� ��/a-/ o 9 <br /> ICA <br /> EMERGENCY/FIRE NUMBER. ROAD NAME M ei S z 0,6jAr rwr ''%% <br /> LEGAL DESCRIPTION(see tax receipt) T 3 C`S m Ca <br /> N o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> w' <br /> SANITARY PRIVY F <br /> ILLING/GRADING-CAMPING UNIT SUBDIVISION 0 <br /> ca <br /> STRUCTURE/ADDITION USE: [ ��D IBJ 4e�' (o /Y7Z. S 6i q <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 00 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C 0 <br /> NORTH(N). m 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO W v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. g <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- f <br /> INGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I; <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 /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ) <br /> ISSUED. 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c y1 <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Q I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C <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 -0 Clm6. <br /> g0�09 <br /> v $ C <br /> 7. <br /> Z : <br /> A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; ZS E E ? c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of J E o.E E <br /> all information contained in this application(Including any accompanying schedule)and 1 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- 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 S m <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other E m E E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of i (T <br /> SIGN HERE <br /> (sign of owner or Ilding contractor) .,i ± (date) <br /> ZONING ADMINISTRATOR \.J l l)1 IGT �• �� ,�'� ' � �1� ` ` ` ` ` � H <br /> NNNN Ath <br /> N NNNNCTN <br /> ---" f O00000 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` `� --- ' 0 0 0 0 0 0 0 <br />