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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator a G) O <br /> APPLICATION FOR LAND USE PERMITS 3 < <br /> �. <br /> N <br /> �7� t1 C <br /> OWNER D lztA 1 /AA�� ��rn JF ut-_ / TELE/PIHONE o (� <br /> HOMEADDRESS ZZt,2 ► KCkry\I -(LK Ko P, l�jl�/� �l iV�L1 Jf�g0 v, 0 <br /> �(J o m <br /> EMERGENCY/FIRE NUMBER Z,6 2-3 ROAD NAME Ak <br /> LEGAL DESCRIPTION(see tax receipt) Se--C 3� (OTS TOwirSlu'D 39 rJo 12"C rn <br /> 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION w <br /> p �1 <br /> }RAGE OtZ-I� g <br /> Cr <br /> s: c— <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> v1 <br /> QaL'��'_::2' <br /> ^'STRUCTURE/ADDITION USE: `�' ��,�� 0� n <br /> (Home/Cabin;Coml6iercial Business; Bedroom; Deck;etc.) -I 3 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �l <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) T o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. "In O , Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m IF q <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <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 i <br /> MUST BE SIGNED AND DATED BY THE OWNER. F c <br /> o 0� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q 0 l}) <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <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. y� <br /> 5. n Ali Aracje t be_ 14+`1 ems}- 3 o J-F Z,r ( , o c�,, + A""'l (�r C O D <br /> 6. �p 3 � t'roM p/ �p m <br /> 1 C n N e 3 <br /> 7. Z F o o Ti i <br /> o : �� <br /> _v, t m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my i : p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- p <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 <br /> CO <br /> authorized person to have access to the above described premises at any reasonabl <br /> / o <br /> SIGN HERE .Q <br /> (sl atur of owner or bu Idl g contractor) <br /> r SEP aMIT <br /> ZONING ADMINISTRATOR <br /> • i i N <br /> ,orL; ' <br /> TOWNSHIP PERMITS MAY BE REQUIR o 0 0 0 <br />