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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 64872 Office of Zoning Administrator v 0 0 <br /> APPLICATION FOR LAND USE PERMITS . < <br /> r <br /> 0 <br /> OWNER �� ✓ !`Y l� JIB TELEPHONE ��'�(!/� j 5/�vC%. � a <br /> 3 VrbU r: Dr. com'l ) M o <br /> HOME ADDRESS <br /> o ' <br /> , / n 1 <br /> EMERGENCY/FIRE NUMBER �•'�`�g,S,L ROAD NAME L.GI�'�;'/�,c3L� .Svty L✓/y� <br /> LEGAL DESCRIPTION(see tax receipt) V <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-X_GARAGE/ACCESSORY STRUCTURE ADDITION C ' l <br /> C Tl <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 Q� <br /> y <br /> C <br /> STRUCTURE/ADDITION USE: /4/O t C <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) M <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ^' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'ZA <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn 1 O <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <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. ` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Iv <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. ro' o <br /> 0 9 ( <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 S jn <br /> 1 <br /> ISSUED. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: Y <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 /> A ' 3 a a <br /> 6. ;M0m <br /> L v' 0cH �' > z <br /> > <br /> 7. See_ �r 61nce, 5� 1 0 : �o . <br /> Z : m <br /> =r/1: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a 9 <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 I am providing will be relied upon by the County ofr ng whether to is. m t7 <br /> sue a permit. I further accept all liability which may be a result o ffiimrein information I am mproviding in this application. I agree to permit county officials c a nances or otherauthorized person to have access to the above described premise any reasona r the p e of inspection. n <br /> m <br /> SIGN HERE MAR 1 3 1998 3 <br /> g are of owrfer or btVdlng contracto (date) <br /> ZONING ADMINISTRATOR�'fVNI BURNETT COUNTY <br /> ka40WhWH� <br /> ZONING NfflN Nf1101 <br /> f11 (110 N rr 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />