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&-Ir) c- <br /> 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 /> N <br /> OWNER o.4 A L 1 l S) 14 N t ♦' ACVO l Z J V 3O <br /> ,/ TELEPHONE <br /> HOME ADDRESS 43`7 -r1&gws/r AaE Gc, /C(�S/'�//UE Mil/ S-S/�3 r- 9 <br /> EMERGENCY/FIRE NUMBER ,;-741VQ ROAD NAME 6*10C&71� R,8 FXT, I <br /> a0M- Z 4176/343 <br /> LEGAL DESCRIPTION(see tax receipt) 5 /T V0 /2/ S-Qj q C 2 FS . 370 ( C <br /> F.O-r Z 2. -440 -/5- 2-0 0 / alto L T C)F S#e4.TC Q iN <br /> c � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n <br /> 5. <br /> N <br /> me <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> N b <br /> �j ((�� p n d <br /> STRUCTURE/ADDITION USE: Q ATN Lo rn C+ C�tD izooln <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) I <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR e <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> c <br /> DIRFrTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> T o z <br /> ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'o <br /> SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C .. o <br /> NORTH(N). W <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 13 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> 0 <br /> STREAM OR RIVER. <br /> SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- Q <br /> INGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> A: IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 10. -0,MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q ° <br /> ISSUED. / C) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c QJ <br /> CONDITIONS OF PERMIT: 70 <br /> �JI <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT /IV <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 /> s. C�rr�Mf 0TN/°�XA 60G Mvn <br /> m oN o -0 <br /> 90as <br /> ;MU <br /> .( � _. <br /> 7. <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a`>�' ` , r <br /> all information contained in this application(including any accompanying schedule)and I furl m �" <br /> that this information I am providing will be relied upon by the County of Burnett V1�isc i �t ' O <br /> sue a permit. I further accept all liability which may be a result of the County of By I m <br /> providing in this application. I agree to permit county officials charged with adm n o nances or o e E m E <br /> authorized person to have access to the above described premises at any reasona me for the purpose of inspecti m <br /> CD : <br /> FEB <br /> J e : <br /> w <br /> SIGN HERE NETT i tur of owner bu Ing contractor) gURNE 1 r(OOU <br /> ZONING ADMINISTRATOR ONING <br /> H <br /> N <br /> CA N Pi 0M <br /> P (TO(lifT00 <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 30 00 00 0 0 <br />