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Burnett Crunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator R 0 o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER �U 6SELL C�RAz�/Q TELEPHONE 4,/�- g,90 3 //);7 O <br /> Q S=5 9^ <br /> HOME ADDRESS 13960SJt/RL&y .yX- pi/�',Usu/LLLI le � <br /> o <br /> EMERGENCY/FIRE NUMBER 2 r7o �ROAD NAME /�c/Dp k <br /> W157VOY e--4*03Fl. /'S• crG. a,Wo� <br /> LEGAL DESCRIPTION(see tax receipt) S oc./7'3 8�/';'/S ,�ar z s 3 P LO <br /> I N <br /> �CFteE"r�s7i <br /> v, _ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING Y GARAGE/ACCESSORY STRUCTURE ADDITION a "- <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> y <br /> STRUCTURE/ADDITION USE: Ls+1B�✓ �XcGc sr �`xisrnuc �r%�cG R/ B V i <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) "o <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. w <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Z <br /> O <br /> InIn <br /> o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. mif <br /> :A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C c <br /> NORTH(N). W <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO m �v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> 0 <br /> STREAM OR RIVER. <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 1 <br /> XJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. SU <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ° <br /> ISSUED. 'r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P (C`). <br /> CONDITIONS OF PERMIT: W <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. `J <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. gg <br /> 5. A03c 'rFL � <br /> . � - <br /> 6. vt � Cinwa> > <br /> - � w o : m <br /> Z <br /> f Haq ' <br /> 7. =w m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G� C <br /> knowledge and belief It is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of C W 56 <br /> all Information contained In this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ; m <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 r&jw <br /> providing in this application. I agree to permit county officials charged with administering count. o _ ler i <br /> authorized person to have access tot the above described premises at any reasons nate purp6se6f i i�s doh. <br /> SIGN HERE I E <br /> i attire er or building contrector) ; fl <br /> ZONING ADMINISTRATOR <br /> -i' O 0 0 0 0 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRE 0 0 0 0 0 0 0 <br />