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co-2`P <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N r <br /> N � <br /> CD <br /> OWNER Q TELEPHONE67` <br /> HOME ADDRESS�b 3 S �. D. l , [�/� �T Q 3 <br /> CD <br /> EMERGENCY/FIRE NUMBER 703 S ROAD NAME D o <br /> LEGAL DESCRIPTION(see tax receipt) I ti <br /> m <br /> c <br /> y o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY vaH <br /> ' <br /> PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Cn <br /> a <br /> nn �/ � . <br /> STRUCTURE/ADDITION USE:_ S Tv Inc. � �% F V1-• ��/X . 7_()/ 5 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) -o <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED, 0 C <br /> •� N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m e <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH (N). y c <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 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- d <br /> INGS, ROADS, LAKE, LOT LINES. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o (� <br /> v $ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q °, <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P G <br /> CONDITIONS OF PERMIT: /iy <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 /> M MW'o 0 CD gm <br /> M • 3 > m a m <br /> 6. v c m 3 <br /> 7. o N m o <br /> y : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (� L7 c p <br /> �i <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of oC <br /> . <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m m ;U <br /> m <br /> that this information I am providing will be relied upon by the County of u 1 r 'nin fwether to is-sue a permit. I rther accept all liability which may be a result of the Co n m tion I am m <br /> providing int s pplication. I agree to permit county officials charged �e i u o or other fib: mauthorized p rso to have access to the above d ribed premises at an sonable time or e r spection. <br /> m : <br /> JUN 12 1998 <br /> SIGN HERE v� <br /> (signature of owner or building contractor) (dat <br /> � ////���� BURNETT COUNTY (� <br /> ZONING ADMINISTRATOR 1 m (�tl ��1 ). ` '' '' `. '' <br /> wFn enFn <br /> - cnfscn-+ <br /> - - <br /> N N M N N M M <br /> Vt P O P (n O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0�o <br />