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czntif'a <br /> Bbrnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PER ITS 3. <br /> r S <br /> 71 JV <br /> , / Q � N <br /> OWNER c Z // TELEPHONE o O <br /> 7 ` ) / A 0 <br /> HOME ADDRESS / /G�-2 3 ��"/t. S�'_ D�r77�✓c�v✓f <br /> EMERGENCY/FIRE NUMBER ROAD NAME �ljLj' !� S7 v W <br /> LEGAL DESCRIPTION(see tax receipt) �� 1cn <br /> Q° <br /> TYPE O PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION v <br /> n� <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> y Cn <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) vCD <br /> ll <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 V/^) <br /> � ' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o c <br /> -n7C 2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). Cn <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, <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- Cqj <br /> INGS, ROADS, LAKE, LOT LINES. () <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <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 <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 /> � d = MOM <br /> M <br /> R � 3 me �ca_ .'O <br /> 6. c <br /> w � m c m N o m 3 <br /> N H O O 0 <br /> 7. o : <br /> Cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my LN ,0 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C : o Et <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0. D <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 Q [ m <br /> providing in this application. I agree to permit county officials charged with administering county or finances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the pur ose of inspection. m <br /> ro <br /> m : <br /> SIGN HERE <br /> (signature of o er or build contractor) Oslo <br /> ZONING ADMINISTRATOR :: 1��� <br /> erwE»Enui<n� <br /> N NO� NN [T Ut <br /> VI 0001 V• 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0 0 0 0 0 0 0 <br />