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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> u r <br /> 0 O <br /> N � <br /> CL <br /> C <br /> OWNER��� IJ (� '� TELEPHONEo <br /> �y � J � <br /> HOME ADDRESS D 7 ' ,r ©L �O e V( C TG A I A(] SS 3$6 <br /> EMERGENCY/FIRE NUMBER S�i ROAD NAME /3 T 1 U "O I MQ" <br /> � �� <br /> LEGAL DESCRIPTION(see tax receipt) ��V { W 1 5 — �s l m <br /> n <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION �}— <br /> CL <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION `;Cn � <br /> �J C <br /> STRUCTURE/ADDITION USE: I ( r*`E P ry { O n C N d (� G N ici a ` i ES -b <br /> Ffomd/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR .. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> T 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M n <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S)TO m Z <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),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. N I <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. c <br /> Cr <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. o <br /> CONDITIONS OF PERMIT: <br /> CT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1:J N — <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. x - 0d 0? vv <br /> tt�ppl m <br /> 6. . � 3 <br /> 7. o : RU, <br /> =q m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i a` E ` S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnegwis in in their to is- m O <br /> sue a permit. I further accept all liability which may be a result of the Con tion I am m i <br /> providing In this application. 1 agree to permit county officials charged i o or other ; mauthorized person to have access to th boa escribed premises at any rp o n ction. -n <br /> m <br /> SIGN HERE MAR 1'� 900 ^ ( <br /> ( lAofnor or uilding contractor) (date) �--" <br /> ZONING ADMINISTRATOR BURNE;TT COUNTY <br /> N 40 iNiR <br /> In N N <br /> V7 pl O fT Ill <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br /> 00000 0 <br />