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Ir7-) <br /> BurneWCounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o c <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r- <br /> N � <br /> (�' �1 <br /> OWNER J Pry£ S 1 1 g C� TELEPHONE <br /> n N <br /> HOME ADDRESS 6'�; kj i S�o r cJ c I L L <br /> EMERGENCY/FIRE NUMBER ROAD NAME \ <br /> LEGAL DESCRIPTION (see tax receipt) fie- ' c7 � I vn <br /> CD <br /> r. <br /> y o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING 2�fE/ ACCESSORY STRUCTURE ADDITION Q <br /> o- <br /> m <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 n <br /> c or <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. F5 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <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 AND MEASUREMENT TO WETLAND AREAS. o <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. :E 0 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o ) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <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 /> M <br /> < N ID d m <br /> 6. m � <br /> M c y " 0 9 3 <br /> 7. o MW: <br /> _ Cn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of MC <br /> CL Er <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m ;a <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- aO <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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> CD : <br /> ID : <br /> 4 69 <br /> SIGN HERE J <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR �iT` �1C�T11 . . . . . d, <br /> to t»t»to EA fA <br /> N (n NN(lUt <br /> Vn O P P O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />