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C�1 C''Gyr�,a <br /> Burnett Ce:-unty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0z <br /> APPLICATION FOR LAND USE PERMITS 3, <br /> r <br /> UT 0 <br /> OWNER Z4LA4f�Lr10 TELEPHONE ��� -��� o <br /> o m <br /> HOME ADDRESS 2��7/ �fGr��/l /)�l� (Ilmrley- wz ('f�93 <br /> EMERGENCY/FIRE NUMBER Z�t`J ROAD NAME <br /> 46 or 16 <br /> LEGAL DESCRIPTION (see tax receipt) SIh V <br /> oeO7 _Zn 6,9P /TS 2 f 3 /✓�/v� <br /> �Cr m <br /> N 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING--(S;?/ACCESSORY STRUCTURE--OX—ADDITION X <br /> v <br /> CL <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: � b;' <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 T 3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. !, <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O CL <br /> T z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 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 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, v <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. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS > >CJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P I <br /> CN <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. V <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. Q, <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, rl�J <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. I� <br /> U �Ir Ir m m°r a 0m <br /> 6. too <br /> i N <br /> 7. MAY z . y :M � � <br /> P : <br /> len : m <br /> I declare that this application (including any accompanying schedule) has bee examined by me an o the t of my (j c A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am �tt etail and curacy of /KC�1E, a ': C <br /> all information contained in this application(including any accompanying schedule)an �tt X=671�at I recognize �Q: � m : m <br /> that this information I am providing will be relied upon by the County of Burnett WiSCO Idla)04emining whether to is- Cl <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> J <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. <br /> qD m : <br /> `° <br /> SIGN HERE <br /> (S1*gFrtULR of ownulld ntractor) (d t <br /> ZONING ADMINISTRATOR o� <br /> fn v+v+v+vw to <br /> N N U 1 N N u7 N <br /> N u7O (/1 BOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED S 00 0� 0 0 0 0 0 0 0000000 <br /> zl <br />