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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o a, <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> w <br /> '� JJ I � <br /> OWNER /Z U C C q 9(,h� TELEPHONE <br /> m <br /> /� O <br /> HOME ADDRESS /7/ F ,COS 1 LA-we s tom /-ya. )55L,�.JTA aan . 3 39S6 9 <br /> 0 W <br /> 0 <br /> EMERGENCY/FIRE NUMBER ,I-oT `00 13 ROAD NAME �, X,4,,ye C ~ <br /> /' N <br /> LEGAL DESCRIPTION(see tax receipt) � V3 1 Ka�P l"7,PP,, <br /> e <br /> N <br /> TYPE OF PERMIT(S):DWELLING/BUILDING A--� GARAGE/ACCESSORY STRUCTURE ADDITION— <br /> SANITARY— <br /> DDITION SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> / m (b <br /> STRUCTURE/ADDITION USE: City[�� J fir� <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 3 l <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> Z <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 r- O <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- nn}} <br /> INGS,ROADS, LAKE, LOT LINES. C <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 64� <br /> MUST BE SIGNED AND DATED BY THE OWNER. D10j <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q S 1 ' <br /> ISSUED. Cr V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c Q <br /> CONDITIONS OF PERMIT: yj <br /> 1 <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. so <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 T1 IoM <br /> m =. a, 5 � Am <br /> 6. v' CL <br /> � cH '" o53 <br /> =rn : ? m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my v'i c O <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m C <br /> n <br /> all information contained in this application(including any accompanying schedule)and I 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 y D <br /> sue a permit. I further accept all liability which may be a result of the County of Bu at <br /> providing in this application. 1 agree to permit county officials charged with admi r un r s to E <br /> authorized person to have access to the above described premises at any reasonabl FI s -n <br /> Co <br /> (D : <br /> SIGN HERE —� M fn E i <br /> r Plif <br /> &4 : : : : : : : <br /> (signature owner or building contractor) da e) <br /> ZONING ADMINISTRATOR I(Yl ll g11RNFTfCOUNTY ' ' ' <br /> ZONING �NNN�� <br /> N Np1 N NfJ <br /> tTi Vt O Vt V7 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED c <br />