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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator Uo Y � <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNER VA 0,6 rLG(J,y TELEPHONE a g <br /> _ m <br /> oo�HOME ADDRESS U 7 c0 o p e4 ✓ - &_ J 'U Lam' -� NGS S I <br /> r e <br /> EMERGENCY/FIRE NUMBER Z ROAD NAME VN& D S Q. Q. .. C <br /> I_oT-3 4- 4 of Ger 1 to r�QN^ /r 1 � UeL ?, * OI <br /> LEGAL DESCRIPTION(see tax receipt) (J`&S 1 v-- V 'i4`P �'"�" �`-''�`[� t� Ge�r�orS 1 ur <br /> 2�3 J 1^ S.ty 1 29 T >�L a 4 D A) 2H I f R <br /> 0 <br /> C <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION- <br /> SANITARY- <br /> DDITION SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: CXl canI > J aT/X.a)l <br /> (Home/ abin;Commercial Business; Bedroom; Dock;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR I r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> FL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S 'q <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE Im rt <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO fill a <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. m o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q :, <br /> ISSUED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. _ <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 /> pgg <br /> 6. � ' "� ' $ k m <br /> .� a o. a .� <br /> v <br /> 7. o : m e <br /> I0) T <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my [ 4Z g 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 i i om E <br /> all Information contained in this application(including any accompanying schedule)and I further declare that 1 recognize ' m n i E A <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- m ` G <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 E m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection, m <br /> SIGN HERE <br /> signature of owner or building contractor) (date K15 <br /> ZONING ADMINISTRATORr 5J,O IT tnn. P <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o i 0000 <br />