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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r o <br /> y O <br /> c <br /> OWNER WRyif/E R. G'l _S 2-4r:S0i4/ TELEPHONEo <br /> (7ts) 3a?- 833 a <br /> d <br /> HOME ADDRESSO <br /> Pte. IIoX /73 aoG3G /�it'EEDc.y� D�e� vE �RCeE2ee� w2 -SyB3� 0 <br /> r m <br /> EMERGENCY/FIRE NUMBER a o G3S'e ROAD NAME } o <br /> FREE Dont Drz! UE <br /> S. io-77 .,OC- 1./ Ya 3 SW NW EX. S 438_5' <br /> ) <br /> LEGAL DESCRIPTION(see tax receipt) . % 3 % LtV� Cn <br /> 0 <br /> Cn 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE XADDITION Q <br /> a <br /> 5.N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 (� <br /> U) <br /> 0 <br /> STRUCTURE/ADDITION USE: S/fff A.✓o STo.ey6-s -' <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) � <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 3 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) O m <br /> n a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 25 m 0 <br /> W oA <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). a 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m wv <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. :E <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o �r <br /> CONDITIONS OF PERMIT: <br /> i <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. <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 /> Mvnr v�vv <br /> • d ; �r f m <br /> G <br /> 6. fN V N �' _ <br /> 7. 3 <br /> a m C y o <br /> Z y; J� 4 <br /> O <br /> 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. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> m C <br /> all information contained in this application(including any accompanying schedule)and I delare that I recognize 'm m <br /> that this information 1 am providing will be relied upon by the County of tt i6 Pp (tete mining whether to is- <br /> sue a permit. I further accept all liability which maybe a result of'"C o�404 t`� his information I am d <br /> providing in this application. I agree to permit county officials cf Ittf d�tiArs�enng coun rdinances or other E m ` <br /> authorized person to have access to the above described premia reasonable time for the p Ose of inspection. <br /> m <br /> SIGN HERE q 18 ' <br /> (sl at a of own o15611ding contractor ( ate) <br /> UR�EI, CCU <br /> ZONING ADMINISTRATOR B E [ <br /> t �lt»wwtncntfl� <br /> N N (T N N N VI <br /> (l (lO fT fT O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />