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Burnet:county 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator L �a o <br /> APPLICATION FOR LAND USE PERMITS _ 4 <br /> 0 <br /> C m <br /> OWNER / e� GI Ni ��MO` [{. WIQI�SCII Ci`ry TELEPHONE�j�,) (Ps—(, .-3o q•c .a <br /> 7 ? t� 1 <br /> HOME ADDRESS 300 V 9 M ?Vf_0%L/cL R D Da AAgh N Wr Sq A"4 D c �1 <br /> EMERGENCY/FIRE NUMBER 3 O 3�/ ROAD NAME M , A)e M(/rt R w <br /> LEGAL DESCRIPTION(see tax receipt) QQQ3y <br /> is <br /> N ? <br /> TYPE OF PERMIT(S):DWELLINGBUILDING GARAGE/ACCESSORY STRUCTUREX—ADDITION `c <br /> o. <br /> IN <br /> SANITARY PRIW FILLING/GRADING CAMPING UNIT SUBDIVISION 03 _ <br /> STRUCTURE/ADDITION USE: L/NI Q <br /> (Home/Cabin; Cw mercial Business;Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR ,n I — <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. III jL <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T 2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE on .. O <br /> NORTH(N). N G <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO on 3 <br /> CENTERLINE OF ROAD,(C)BUILDINGv <br /> 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 i <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> v � Ute.) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. zo <br /> CONDITIONS OF PERMIT: _. <br /> l <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. N <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. -0 0py Q F <br /> 6. RA.* a2d lE 'P � <br /> 9. <br /> wcc m o� E <br /> w� 0.,5' <br /> o [ <br /> y [ on <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize A <br /> 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 Bu rel Ing on this Information I am <br /> providing In this app cation. I agree to permit county officials charged with admin irlwc <br /> authorized person tgfhave to 1he above scribed premises at any reasonabl too ose <br /> SIGN HER �/.c�-� (Nr''``• <br /> signature of owner or building contractor) I • I - ,�)lM1J <br /> ZONING ADMINI TRATOR 71 I iY) <br /> l\N MHN MND <br /> N Nfa N Nb,rT <br /> N O C N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o'0 0 0 0 '0 <br />