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�i <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. 4 <br /> n �1 f N O <br /> OWNER 19M Af0t, 1\Qh ' �ei ; TELEPHONECLCF <br /> +�,.r �� -s�� -9�9 0 <br /> HOME ADDRESS LJS-ICj <br /> I/ <br /> ! i \ y LtY I�A s <br /> �`��tV 1 564oll 9m <br /> EMERGENCY/FIRE NUMBER ROAD NAME k�nb2"�N112S CT Q 11�� <br /> v 1 <br /> LEGAL DESCRIPTION(see tax receipt) - l� � t \m <br /> 1� o <br /> y o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION <br /> v <br /> n <br /> SANITARY PRIVY—,V, CAMPING UNIT SUBDIVISION 00' <br /> —SQ14 . 801f-=14Nc 3y WA4c 90- 3tOLPA s =Wfbe vlt� T4*-1 Fm"ClI � <br /> STRUCTURE/ADDITUSE: for) -y <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 11 r. <br /> ;a w <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) 0 c <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 o Z <br /> m IF <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M j��a3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, " Z <br /> STREAM OR RIVER. 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 /> INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. UCJ <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. c <br /> U3 <br /> o 9 W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a 0 C�, <br /> ISSUED. Cr x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z VQ <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT J <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 OH <br /> WM OF TAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. sp cp <br /> 6. R � 3 ng L <br /> n <br /> 7. Z i m e i •'f0 <br /> =y= m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c i i p <br /> knowledge and belief it is true,correct and complete. I acknowled a am responsible for the detail and accuracy of m g ? C <br /> all information contained in this application(including any accom vying chedule)and I further declare that I recognize CL <br /> m ; m <br /> that this information I am providing will relied upon by the Corhi!'a <br /> of melt Wisconsin in determining whether to is- (�;' ' i i7 i p <br /> sue a permit. I further accept all liabil' which may be a result C my of Burnett relying on this information I am <br /> providing in this application. I agr o per county officialsg with ad Iste ng county ordinances or oth CDauthorized penton to have access a ab de cri d remisy reaso le tim for pectiWn. <br /> F �. <br /> SIGN HERE <br /> l i <br /> (s nanatuurre of owner or bu ding con ctor) ( A ,r '� <br /> ZONING ADMINISTRATOR V I L !{ <br /> w w w w w <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />