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Burnett County 7410 Co. Rd. K, No. 102, Siren,W164872 Office of Zoning Administrator v c o <br /> APPLICATION FOR LAND USE PERMITS <br /> La " <br /> Y OWNER i _T_1( L �•�U( _t+— TELEPHONE <br /> 4100 f ?� <br /> HOME ADDRESS PjV 0 AiK All, 0 '�i-Ta A <br /> EMERGENCY/FIRE NUMBER a yb 6 ROAD NAME I A S})P--Aj cD c .- <br /> LLOT- L� C s nn -i 119 1 1 IFF0 Ll <br /> LEGAL DESCRIPTION(see tax receipt) j t) VOL.- j Lf tj'I f ytS -Doc ;t& 77 0 f, � <br /> a <br /> �/ <br /> y0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION- C ' <br /> Cr <br /> Cr ✓\ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION— <br /> 0) <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 �1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. —yam _n ^' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) �T .H �>r 0 <br /> ?� 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 IF <br /> NORTH(N). N 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rn a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. 9 <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 64 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,� o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a <br /> ISSUED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r <br /> ISSUANCE. lJ <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 /> ;a _ 3 ' � m <br /> MU <br /> 6. � � ao3 <br /> wo <br /> a C . <br /> 7. c mQ <br /> 00 <br /> � <br /> =cni i i m <br /> I declare that this application (Including any accompanying schedule) he Q+j�tq 5ognize <br /> of my s c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 (tis X11 t it racy of i m L7 <br /> all information contained in this application(including any accompanying s r t ' CD m m <br /> that this Information I am providing will be relied upon by the County of Bu Wisconsin in determining w ther to is- y O <br /> sue a permit. I further accept all liability which may be a result of the Cou f Burn r lyin9� Info on I am d E <br /> providing in this application. I agree to permit county officials charged w dmini g =941nan or other m E E <br /> authorized person to have acces to the above described premises at any a able time for the purpose of action. n <br /> m <br /> SIGN HERE BURNE U <br /> (signature of& ner building contrac Z (date) <br /> ZONING ADMINISTRATOR h <br /> KL <br /> 4nw H fn 49 <br /> N N N N M O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 000000 <br />