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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrate z <br /> APPLICATION FOR LAND USE PERMITS 14 <br /> e S7 Iq m r <br /> OWNER ����� �►R b/ Z'Z/3a <br /> TELEPHONE <br /> ,9- S5- 73 / ) C,\ <br /> v Y <br /> HOME ADDRESS O� j \_j 'A\ 5 �y I� <br /> EMERGENCY/FIRE NUMBER 5�j ROAD NAME , i m <br /> t5a2v1r, S l�tnC <br /> w <br /> LEGAL DESCRIPTION(see tax receipt) ^ m <br /> v/ N <br /> a <br /> rn o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING---K—GARAGE/ACCESSORY STRUCTURE—ADDITION- <br /> SANITARY— <br /> TRUCTURE ADDITIONSANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> m <br /> V1 <br /> (Home/Cabin; Commercia Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE ORCD <br /> n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n o. <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS (NB)AND INDICATE m :? <br /> NORTH(N). C ° o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m !o' <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, W <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N51 <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. o <br /> _v, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a ° <br /> ISSUED. <br /> 0 5 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o i <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ) <br /> ISSUANCE. I <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. X :? 0 g ?r Da O m <br /> .J m ` 50Mm <br /> 6. �3�S-:7Uj 3o Ste. �` � � y0ofic <br /> o yN <br /> — a : m <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. 1 acknowledge that I am responsible for the detail and accuracy of o C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information 1 am providing will be relied upon by the County of Burnett isconsin in determining whether to is- <br /> sue a permit. 1 further accept all liability which may be a result of the C r T o -this information I am m <br /> providing in this application. I agree to permit fficlals char i r g rdinances or other m <br /> authorized person to have access to a ve scribed emises a o�t e e of inspection. -1 <br /> CD <br /> SIGN HERE <br /> APR 2 9J46/7 S �- <br /> (sl nature f owner or Ing contractor) LJ U tdate) <br /> ZONING ADMINISTRATOR BURNETT COUNTY <br /> ZONING <br /> N Nfn NN [n Ut <br /> Ut Vt O ut Vl O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />