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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> A <br /> f // � w <br /> OWNER /iY)Gc �-^nc��'�hl�.J�h TELEPHONE <br /> cc�� cw (� <br /> HOME ADDRESS �/�QeJ-y / �c � � �1"�)hr,e�,e+a/5 m!!9 .S.S'/�D -�2`/""- l � <br /> r � <br /> EMERGENCY/FIRE NUMBER 1302 6- ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) .4 ��� / 214Y 224)— yD—1 y \ <br /> P C.cto <br /> ,�`/, O <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE�ADDITION O CO <br /> Cr <br /> Q: <br /> s: N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: <br /> ray �8 X aq <br /> Ir <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) -a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> fi <br /> DIRECTIONS FOR PLOT PLAN D AWING (AERIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <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, <br /> STREAM OR RIVER. z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- P <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 41 3�3 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS S <br /> MUST BE SIGNED AND DATED BY THE OWNER. c I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATI NJ�FORE A PERMIT CAN BE <br /> w o <br /> ISSUED. jug <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z�' <br /> Z t <br /> CONDITIONS OF PERMIT: ,,-. P _J <br /> V� . <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYSERMI1#4Y ? �, ~ <br /> ISSUANCE. l <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SH 002 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY�Tr cO <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF ILn <br /> ps OF LA S, Ln <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. TF <br /> 5• This structure to be used as private residential <br /> garage/storage only. Not to be used for human A ' m L m <br /> 6. 3 n Q. <br /> habitation. M:� � ; <br /> C); x <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my E ` m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m ` C <br /> all Information contained In this application(including any accompanying schedule)and I further declare that I recognize ie B m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G� p <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> / {/ o <br /> SIGN HERE C.Oh3 �-J ati ��� j �� N <br /> (signature f owner or NoWng c ctor) (dam) <br /> ZONING ADMINISTRATOR <br /> �H NNNHNH <br /> N NCAN NNN <br /> f7i ETON N 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />