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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> 640, <br /> / 0L PS N <br /> OWNER (�tC TELEPHONE Z - c ~ <br /> C �1 � c- K � ►�riso ,y �� yis- x783 0 <br /> HOMEADDRESS CJZ CC) �yC /, /f7) $ r" <br /> &t�xjtv< Ifi7e} 0 <br /> Em <br /> MERGENCY/FIRE NUMBER ROAD NAME <br /> ,(CFS l s Z- 44 <br /> LEGAL DESCRIPTION(see tax receipt) -r-urn�4) L of S S _;'_ec 3 t7 T<11 fj62 A'Ld <br /> Q <br /> N o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREADDITION a ' <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> CA <br /> �(� 7 <br /> STRUCTURE/ADDITION USE: 0 7`I R6 -- <br /> [S <br /> K <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) � <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m - <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M tz <br /> n <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- L 1 <br /> INGS,ROADS, LAKE,LOT LINES. V" <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. to <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE `" <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: ryry <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT v �J <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. <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 /> d �e <br /> = m <br /> a <br /> 6. v � Ctn " o � 3 <br /> � , �m <br /> 7. 0 : i A <br /> _co m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ii <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o 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 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 m' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> to : <br /> SIGN HERE ' <br /> (signature ofAwner or building contractor) ( a e) Q} <br /> ZONING ADMINISTRATOR rTl c <br /> H <br /> " N 0 <br /> N N M N"N"N N N <br /> tT (TOtiI�OO <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />