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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Anistrator � o Z <br /> APPLICATION FOR LAND USE PERMITS 3. ° <br /> r (� <br /> 0 <br /> N \. <br /> N <br /> OWNER h N A P Na G TELEPHONE 909- 6-o .261 �MM <br /> HOME ADDRESS // v W <br /> !O 7l /-/,C,.4 1A,t+al Pr ,0,, <+C `Cr3`rso 7 Z 9 <br /> 1 r c— al <br /> EMERGENCY/FIRE NUMBER Rd ` o r <br /> 9178 ROAD NAME (,,k 1 S <br /> o� <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> �i <br /> e <br /> Vl o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ CCESSORY STRUCTURE ADDITION Cr <br /> C <br /> c. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> ur <br /> m <br /> 1 / <br /> STRUCTURE/ADDITION USE: GAcZG <br /> rC S Y or AIC � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> Mz <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 1 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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. N 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. o <br /> v � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. zU <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <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 LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> L. ,se cy, tq ->-bra ;a v a iv o 0 m <br /> 6. a mCvyyo � 3 <br /> �U� marl <br /> 7. z : y " 1 <br /> � '0 <br /> o : <br /> lo,: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of c a C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mi m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ` 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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other d m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of ins ectio n <br /> SIGN HERE � <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR J i m . . . . . <br /> Fn w v+fn cn d+- <br /> N NNNNNIT <br /> V7 (T O U�VI 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />