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5) cp y <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator V o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> c o <br /> OWNER AJ a e bF1r c r^�p 1F 1 TELEPHONE <br /> HOME ADDRESS Pc eb j y kip. $511 Z j <br /> EMERGENCY/FIRE NUMBER tPJ G101^ 536-/O4'7 ROAD NAME KW_ At-tiiu s <br /> L. I� <br /> LEGAL DESCRIPTION(see tax receipt) tor-" 15- �(��jt/ 2t.j><,V L,7� v` to <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION � <br /> c <br /> Q: <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> m <br /> STRUCTURE/ADDITION USE: fif `1 <br /> (Home/Cabin;Commercia usiness; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE c <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. <br /> 4. SHOW THE LOCATION OF THE WELL(0),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- C,3 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O <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. c 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Q J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <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. M �. �0rm- oLo -06. <br /> NX m <br /> 7. o <br /> �� ii i ;0 <br /> -y: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my dj c C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am res able for the detail and accuracy of n <br /> all information contained in this application(including any accompanying ached ) d I further declare that I recognize m m m <br /> that this Information I am providing will be relied upon by the County of Burne Wi onsin in determining whether to is- '• v <br /> sue a permit. I further accept all liability which may be a result of the County fB nett g on this Information I am m <br /> providing in this application. I agree to permit county officials charged wi ad I s ring ounty ordinances or other m <br /> authorized person to have access to 94 above Opscribepremia y e i T <br /> _ m : <br /> SIGN HERE <br /> ( gn re of o r or building contractor) <br /> ZONING ADMINISTRATOR <br /> ,t ,u 2 419gf � H <br /> V1 lR N 40 44 <br /> NNNN VIN <br /> `� Vt wO0N00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED _ _ 0 0 0 0 0 0 0 <br />