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Burnett C.Qunty 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U 4 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> e Rias ?. <br /> OWNER rn F}S �L( �T l9 Se N {STL-Y�TELEPHONE E (�p ' 5-6 Q-3oZ^JJ 0 <br /> m <br /> T 6/ O <br /> HOME ADDRESS Q 9 Nog /11 r /S <br /> o � <br /> 2 c / 0 <br /> EMERGENCY/F=IR'S UMBER 3 w) � ✓O PEO'1JI�AJ5aO ROAD NAME p ` <br /> 53i/ 7 1/o / R�scvD / _ l \l N <br /> LEGAL DESCRIPTION(see tax receipt) �0� Ll Sm r r /•2 7 ( I� Ko v/ `OT J <br /> m 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION X Cr <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION Cn <br /> C/F�3j <br /> STRUCTURE/ADDITION USE: V b4ce 00 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n) c <br /> NORTH(N). N T <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, I Z <br /> 0 <br /> STREAM OR RIVER. <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. O <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 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o /" <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE g <br /> ISSUED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <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, p <br /> PONDS, /RIVER UNLESS SPECIFICALLY PERMITTED. ll � ,n,�n v§ <br /> 5. ,DeZ k`tv` dQ SA�+e S'l a— � `�` Lx� �� �/`� a v ' m <br /> �. d m <br /> / � f � 3 <br /> 6. P�Cevd a <br /> m N o w ,m q <br /> �i?C-� reDl2/I�e� <br /> UAL ! o ' " �� : M <br /> 7. U� l/VOwCon�O t -cr <br /> cr: m <br /> I declare that this application (Including any acco m <br /> panyg schedule'r has been examined by me and to the best of my IS <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Q} M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. - : <br /> m <br /> 2 ^FE <br /> SIGN HERE `(date) �J <br /> ( gna re of owner or buil in contractor) I <br /> ZONING ADMINISTRATOR { '^'^40 un ri d'd' <br /> K)un <br /> 14 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED U t' ---- <br />