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eo <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator/, ` 0 0 7 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNER IV VT Kf� V l> 6 (L TELEPHONE '7 �5 63-5 / Ng' a <br /> HOME ADDRESS : 7 1 o j 00/✓a✓ (j, <br /> m m <br /> EMERGENCY/FIRE NUMBER {� (/ ROAD NAME CT 1q ( 11 I <br /> f C <br /> - 01305 — tZi <br /> LEGAL DESCRIPTION(see tax receipt) Of/) d W -F <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION- v� c ' <br /> a <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> Cn <br /> M <br /> STRUCTURE/ADDITION USE: A/0 <br /> 0 grime <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) ,C <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE O�J �539� 3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. /i��� O N <br /> / x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) / SAti / C In a <br /> it <br /> 11 fa,0 lsh Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. See fbr ����G� C7 m 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m g <br /> NORTH(N). Cn 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, I Z <br /> STREAM OR RIVER. P <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. 91 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i 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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: I <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. <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 /> 009 <br /> � m <br /> t2�t2op = a <br /> Cw w o 53 <br /> 7. o N (Q � <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m 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 O <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 administering county ordinances or other E m E <br /> authorized person tqjhave access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> 9 �SIGN HERE � <br /> (sig tur of owner or Idl contractor) (date) <br /> ZONING ADMINISTRATOR . . <br /> HHHH��� <br /> N NNNN �fJ <br /> N V7O Vt utOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 o 0 0 0 o <br /> lam,60frr N-IN-fib' <br />