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Yt &"P/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N 0 <br /> OWNER W 1lV -rQjV C O R I S 'rn/Eg TELEPHONE 7/_�9-,Z, 3 CJ^—3z) 714[ a <br /> v <br /> m <br /> c1 1� /' T !� 1 l O <br /> HOME ADDRESS 2 CI 9 7 �c�• 107 ! L AK K ✓,,I�P pc( iA� o � <br /> EMERGENCY/FIRE NUMBER a 6 7 q, ROAD NAME W. C3C;5)1)0 17- ,Lk 1;17 <br /> LEGAL DESCRIPTION(see tax receipt) -y- ^� <br /> 1c a 4e- <br /> � � uJ <br /> c.7 '/\ l yW //, Y �4e- YCS VDV/ 1_O( /7 t� <br /> c. <br /> j <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE co) <br /> ADDITION c <br /> CL <br /> 5. <br /> N , <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> N <br /> Re - <br /> / f� � <br /> STRUCTURE/ADDITION USE: /\e-n/ r-� 49" fa <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) y <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> r o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE IM n <br /> NORTH(N). fn o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> a <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. C <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. v61 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEq 0 <br /> ISSUED. ° W <br /> r <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 <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. J <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 /> 5 � em <br /> n <br /> 6. 0. � v co w o E 3 <br /> Cn: m <br /> a E m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of a g '• S <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize <br /> m W <br /> PP ( 9 Y ) 9 m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y 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 0 E E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> _. m <br /> m <br /> SIGN HERE <br /> (si atur of owner or ui ng contractor) (date) <br /> ZONING ADMINISTRATOR0 H h �,�,H <br /> �, N NNNN (n Oi <br /> I N utONutOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED co c no c 0 <br /> CD c o <br /> i. _ <br />