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D 72CJ-�-� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - c a <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNERQ R�t r5 ,� TELEPHONE 651 <br /> c,0..bin. Mpg(n1 9tA,r4ZSs : 10 LltaotC ®IW O <br /> 1t EADDRESS 'ja.Q�$ ? fjr <br /> jSM O 0 <br /> o �^ <br /> EMERGENCY/FIRE NUMBER ROAD NAME J_b lrj,•D n ^ <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 0?0/ D a Nrs���a q�� q:j1- j ,45-4/ \� ! <br /> LC#3g 53,1_ /6d V LoTz !8^3 41 GOP <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE X ADDITION- <br /> Cr <br /> CL <br /> 5. <br /> Lo. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> w <br /> n�� d <br /> STRUCTURE/ADDITION USE: ���1� e C.1< Qe-ernP h:f" <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) b� i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR I <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> CA <br /> in <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 8 /� I <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 Gv� <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. 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. <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. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT V <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <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 <br /> �,,UNLESS <br /> ,SPECIFICALLY PERMITTE�QQ p� �-�j Jp� <br /> 5. D�G/Q�dG//(�KJ Qb SI WL G� Ll - , - WD �J - <br /> / QX IV 0r- O�o �o <br /> n')� Once 4� i y Lt `� LCb 9 : H o <br /> Z '" m,Z <br /> o <br /> 2!: <br /> C): m <br /> declare that this application (Including any accompanying schedule) has been examined by me and to the best of my 2 IS <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E c <br /> ' i <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ' m w : M m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m D <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E m E E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> 0 : <br /> 0 : <br /> SIGN HERE 67/16 Aq <br /> (j§nattte of owner or dl contractor) (date) <br /> ZONING ADMINISTRATOR w <br /> w w w w w u <br /> N NfTNN (TIN <br /> to U1 0 N 01 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />