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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 64872 Office of Zoning ng Ad�ator -0 0 0 <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> r <br /> N <br /> c <br /> OWNER t/Yn I(a 3/j /6leC A+ TELEPHONE m <br /> �/�� <br /> HOME ADDRESS �4/00 (�' �j LANG f.//ly ��./C S ////LJ SZT 7 <br /> (/ 0 <br /> EMERGENCY/FIRE NUMBER aOyS ROAD NAME S22 <br /> 1 ~ <br /> y,^ <br /> LEGAL DESCRIPTION(see tax receipt) /C �� �/ S,v` # 3� � <br /> G O� <br /> N o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION v <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING�1NIT <br /> STRUCTURE/ADDITION USE: v !X rQ fiP <br /> (Home/Cabin;CorWmercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. C ^(� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 1 <br /> ,t o is z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m c <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. <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. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE o �, <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT v <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY li <br /> PERMITTED. C11 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FE"F THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> -0 0rcfc' � o, m 0 <br /> L� m <br /> c�� '30 MX <br /> 6. �/ ��.'��_�, v' . vCrAmoa � <br /> . � wao om <br /> 7. .4A z : , :d <br /> �' P =o' m <br /> I declare that this application (including any accompanying schedule) has been ex me an t best imy a g E C <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsibl detail a accur of n <br /> all information contained in this application(Including any accompanying schedule)and I f� that re ize m m m <br /> that this information I am providing will be relied upon by the County of Burrett Wisconsin t Is- m : a <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on s Info rile I am m i <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. -n <br /> 3'9 <br /> SIGN HERE <br /> (Adnatu—revof'oner or building contractor) (date) <br /> ZONING ADMINISTRATOR m Dhu2 1 ` h <br /> h Hbi NtAN0 <br /> N NfJiNNt7 <br /> ut NO V7N OOP <br /> TOWNSHIP PERMITS MAY BE REQUIRED (C�(0 0 0 0 0 0 0 <br />