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0 ea <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator G) <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> w <br /> _ A� <br /> OWNER \J AA) ET FRL��i y t TELEPHONE <br /> m <br /> HOME ADDRESS L CJ{� $ O <br /> G ,1�� .�U .i rTL mn1 f o it <br /> EMERGENCY/FIRE NUMBER l 43 ROAD NAMES <br /> LEGAL DESCRIPTION(see tax receipt) 6. r <br /> , vga <br /> c <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> a <br /> 5. <br /> �. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> lir <br /> STRUCTURE/ADDITION USE: `1 .C-� l.� I rnZ�YY� B <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. lJ" <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> � a Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'q <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C .r L O <br /> NORTH(N). y 00 3 <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- (� <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' e <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 91 1 1 <br /> ISSUED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. e <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Z� <br /> ISSUANCE. 1U <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. NL) /Y101-t p A&Qcfi wo o- l our S v% /s IA wd ar - 2M2 s m m Qy 40$k o <br /> 6. <br /> 7. Co -s��/-YI6J�. G c7 v� D ���l%4/ h P p a tQ 1 p <br /> m <br /> I declare that this application (Including'any accompanying schedule) has been examined by me and to the best of my i i IS <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o. <br /> all Information contained in this application(including any accompanying schedule)and 1 further declare that I recognize 4.1E i m m E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m D <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 hav cceas/twothe ve described premise at any reasonable t flnspsstLos. T : E <br /> SIGN HERE <br /> ®n tureof ow o building contractor) I (date) '• <br /> ZONING ADMINISTRATO <br /> 276 <br /> HMMM� H <br /> ( L;d _ <br /> �P N O N O <br /> TOWNSHIP PERMITS MAY BE REQUIRE c, 0 0 0 'o <br />