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0�) o& Dl <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o o Z <br /> APPLICATION FOR LAND USE PERMITS . < 0 <br /> a <br /> OWNER /�/ c <br /> i�� TELEPHONE c8 6 <br /> HOME ADDRESS Z I G) S' S 44.7 L1 ! a /gp,�y a 7 <br /> EMERGENCY/FIRE NUMBER Zg i Cr ROAD NAME s-7Zdjj %J <br /> 1 , W <br /> LEGAL DESCRIPTION(see tax receipt) Lt 3 Ll /U �� _ _�3—!/0_/ r \ <br /> 7 � <br /> r 0 P <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUREADDITION c <br /> r5 a <br /> 5. <br /> N <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION <br /> i :a n tVr �C N <br /> STRUCTURE/ADDITION USE: pueflitfr_ a8IY3(o' w Q¢c- —p {acl D(�' oA <br /> PO <br /> (Home/ bin; Commercial Business;Bedroom; Deck;etc.) '80CH r L-v 9,2" <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR \3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. PS �Io� 0 o C <br /> !G/ o/wU f� ;a N <br /> DIRECTIONS FOR PLOT PLAN D AWING7 (AERIAL OR TOP VIEW) 0 <br /> - b Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE fir <br /> NORTH(N). c n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO IM <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <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. 3 c i <br /> $ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c _ D l <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 0 I <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. 13C)gm- I�Uli-�-C -L e CI Q r �f d�� ��3� <br /> U �` A � mm v�v � <br /> s. P�a�/� 74 01.( � _ fr o �� Ties /�?o�-� 1 .0 a OF Q= M <br /> 7. e iu rls Ivo Z N m i '1P � <br /> o : <br /> CO 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 C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> M <br /> that this Information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- v <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 /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. -, <br /> � <br /> CD <br /> SIGN HERE <br /> ( ature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR . <br /> wwfn <br /> N N N N tT <br /> O N N tT O <br /> TOWNSHIP PERMITS MAY BE REQUIRED C 00 0 0 <br /> U-0 e sel-T-1- »- i3-C7 <br />