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1 \ 6 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator n l o 0 <br /> APPLICATION FOR LAND USE (PERMITS �V J. <br /> r/ CD <br /> N <br /> OWNER GtA <br /> er SchGY L S r1 l�`.- $� TELEPHONE 7/4;3 0 <br /> CJI m <br /> HOME ADDRESS <br /> ,QG <br /> EMERGENCY/FIRE NUMBER rJ� �y %�S ROAD NAME 7 /�/�l�I✓G� i o <br /> &L '7 L A -Cssrr, V tl 10l <br /> LEGAL DESCRIPTION(see tax receipt) / t m <br /> n <br /> c <br /> N o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ ErX—ADDITION `v <br /> CL <br /> W � <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> Cf)rn <br /> 3b 9f <br /> STRUCTURE/ADDITION USE: �� /� � V, <br /> (Home/Cabin; Commercial Busines ed room; Dec ,etc.) � <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR -n 3i <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om CCD <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m O <br /> NORTH (N). Cn a <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. <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. O <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. , <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o T <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 0 <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 -J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, Q <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> CD 0) f m <br /> 6. 0. D K M A <br /> COD C m a s 3 <br /> y <br /> Z N O O(p <br /> 7. P : m � <br /> ' U): .� <br /> —a : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for thq'd"ail;and accuracy of CL <br /> W <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize <br /> n <br /> P ( 9 Y ) 9 m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- l7 <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 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 /> CD : <br /> SIGN HERE <br /> s' na o owner or building contractor) ( (ate) <br /> r s <br /> ZONING ADMINISTRATOR <br /> t_u� <br /> �����N 0 N N N <br /> V 001 U1 0 P <br /> 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED dp —I�' o <br /> 0 0 0 0 0 0 0 <br />