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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER 1, ), LFl(2_ �jllqIi1' L111.'1 IV,) Nj.IU LE�EPHONE �UG-�j(�a O <br /> HOME ADDRESS 3 /I .� � Ftil uSuLr� !LQ ' ��Q�S�2 60). 5SI9J <br /> CD <br /> EMERGENCY/FIRE NUMBER �� �/ ROAD NAME J6, <br /> LEGAL DESCRIPTION(see tax receipt) / v 'J� cn <br /> 0 <br /> 0 <br /> V, o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUREADDITION v <br /> a <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION O <br /> Cn <br /> STRUCTURE/ADDITION USE: �jG1Ldd� IJIAI� �A�L'" �I)$L. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) CD <br /> � <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> X N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> _n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 rn 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. 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. `e <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. o <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. <br /> Ila <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �O <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1� <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 /> 6. 2B n CL <br /> m F <br /> CD <br /> y N O 0 <br /> -1 <br /> 7. Z : 41 1< <br /> O : <br /> _ rn : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of c <br /> C <br /> all information contained in this application(including any accompanying schedule r}d,)fyi¢f? lare that I recognize m m <br /> that this information I am providing will be relied upon by the County r i ii�Ild irtlrtg whether to is- <br /> sue a permit. I further acc tall liability which may be a result of r e n `nformation 1 am m <br /> providing in this applica ' I agree to permit county offici s c r stenng county d(nances or other m <br /> authorized person to h ccess to the above described p ises ny reasonable time for the pur se of inspection. T <br /> MAY <br /> SIGN HERE � - <br /> (signa re of owner or building ntra r) B�RNETT CO (date) <br /> QJ: <br /> ZONING ADMINISTRATOR m ING <br /> � . . . . . <br /> N N (n NNIn (n <br /> (n0 (n 0100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o <br />