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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o a <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> ` N 0 <br /> OWNER �ANi�� MIG,E) I��(�S TELEPHONE t`S - 3Z^7 <br /> m <br /> Z 0CI3C7 L►�aCf_=wC3� (� pt` ��.�y- o <br /> HOME ADDRESS �f r� V 1L� pt{� v � <br /> �Yl J r g <br /> EMERGENCY/FIRE NUMBER Zo C1 3 o ROAD NAME <br /> A' <br /> LEGAL DESCRIPTION(see tax receipt)21 —) ti(6-31.4 oS y-7(o X47 SZI tAT'31 �21i3 w <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION' N <br /> c <br /> ir SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> y J <br /> STRUCTURE/ADDITION USE: 'S-rU(0.C3-e_ FJ <br /> 1 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR (Jl <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO <br /> a7 c W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 00'P <br /> 3 <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. <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 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEq ° . <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( n <br /> ISSUANCE. jV\ <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 /> m; o O 9 <br /> 6. 43nwo ' 3_ <br /> a Cto <br /> m <br /> 7. Z i w m Q i ' i <br /> o 7g <br /> o'. : rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Z)c ; A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E C_ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m C <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 m <br /> providing in this application. I agree to permit county officials charged with adminisr6er`IWcounty ordinances or other m E <br /> authorized person ave access to he above decr d at any reasonable Orris for the purpose of Inspection. <br /> remis <br /> CD <br /> If VI jI m l <br /> SIGN HERE U —2 (� (�� <br /> (sig ure f owne r Ilding contractor) ( t i <br /> I <br /> ZONING ADMINISTRATOR E <br /> w w in w 40 40 <br /> -� - N NNNNOO <br /> fJ1 fJ1 O U1(71 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br /> 0 0 <br /> - -� 0 0 0 0 0 <br />