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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator 'a o ' o <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> �+ r <br /> OWNER V Ef%lj Z1 a/f 4 sa N TELEPHONE $' <br /> m <br /> HOME ADDRESS ld q 50 U"Tksolyl, TAI M30 -5 <br /> 0 <br /> o � <br /> EMERGENCY/FIRE NUMBER , RvOAD NAME P E )�nFoyx, , .,Y. wy77 ( <br /> rboN a � <br /> CO <br /> LEGAL DESCRIPTION(see tax receipt) L 6 T ASECTi'6/1 l3 TO U.Ns�gjp y/ Allirrf . §?BA4G616 1 C <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAG CCESSORY STRUCTURE ADDITION m <br /> C <br /> Cr <br /> n <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0' <br /> V) � <br /> �fl <br /> STRUCTURE/ADDITION USE:_ CA h/'A/ m'— <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) a i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O Iwo4� <br /> ;0c <br /> DIRECTIONS FOR PLOT PLAN DRi WING? (AERIAL OR TOP VIEW) 0 <br /> !� O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). 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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- W <br /> INGS, ROADS,LAKE, LOT LINES. In ` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. JV <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS I S <br /> MUST BE SIGNED AND DATED BY THE OWNER. 5. c ^ ` <br /> v 0 J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BECr E <br /> ISSUED. .\ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> ISSUANCE.MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 0 0 I ) <br /> 4-1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. V �J <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 UNLE S SPECIFICALLY PfRMITT`EDD <br /> �ptp <br /> 6. a 3 ng <br /> a m <br /> v c CNo w e 3 <br /> 7. w <br /> 0i i mli'Z i i 70 <br /> ='0 : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my a g : p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m e <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m 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 ? m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> (signatu of ro,)Mild ntra r) (d ) <br /> ZONING ADMINISTRATOR ��9 �_. <br /> W N(N fA Ul <br /> N N VtK)NN01[T <br /> N UiON(n00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 0 <br /> ODC SenT 6-�0-q7 <br />