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Burnett County 7410 Co. Rd.K, No. 102,Siren,W154872 Office of Zoning Administrator o o° c <br /> APPLICATION FOR LAND USE PERMITS 3 0 <br /> /n/ a I <br /> OWNER o7 /G� f K7✓YGi�•r JeE'�C TELEPHONE ��Z' Q���/� � O <br /> HOME ADDRESS 6,JV�/�*jJ�/ '• lZ I <br /> EMERGENCY/FIRE NUMBER a`7.25 ROAD NAME <br /> �A / �7 /� <br /> LEGAL DESCRIPTION(see tax receipt) Lpf-o1 e- al NP,. a 5/ " L-p2 7 ZO 0 (N7 <br /> c <br /> 0 <br /> c <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITI 5 <br /> S <br /> 0 <br /> SANITARY PRIVY FILLING/GRA//DING // CAMPING UNIT SUBDIVISION— <br /> C)y <br /> kA <br /> STRUCTURE/ADDITION USE: -4 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> lv <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. H <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) -n $ Z <br /> ;b71� <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE O <br /> N 0 <br /> NORTH(N). m v <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO 44 (� <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, V V 1 c <br /> STREAM OR RIVER. O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUIL - <br /> INGS,ROADS,LAKE,LOT LINES. AND SHOW AREAS TO BE GRADED OR FILLEDN <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED . <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 2. <br /> 0 <br /> f <br /> MUST BE SIGNED AND DATED BY THE OWNER. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ° o <br /> ISSUED. Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PERMIT Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> CUTTING2. REMOVAL OR RESTRICTED <br /> 3. NO GRADING OR SHORELAND A TERATIONS ARE ALLOWEDUNLESS SPEC F CALLLYLINE . <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAK , <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> z -0OmpRo �� m <br /> 5. � v 'aiOwo- 3 <br /> 9i MC9n <br /> 6. N O o N G,0 A <br /> 7. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zf ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of <br /> m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m: o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have aciless to the above described premises at any reasonable time for the purpose of inspection. - <br /> CD <br /> 40 <br /> SIGN HERE <br /> (signature wn or bu in <br /> H <br /> N fA(q H iA Vl� <br /> ZONING ADMINISTRATORN N vt N N vt N <br /> cn <br /> cnocnviao <br /> 0000000 <br /> TO NSHIP PERMITS MAY BE REQUIRED <br />