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tl CaA�) ' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -u o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> g o <br /> OWNER /0 Q <br /> �/o 1 uA/ eeN eE-1 TELEPHONE <br /> �HOME ADDRESS y ,� ,y� 9 <br /> rr � <br /> Mrr77�� <br /> EMERGENCY/FIRE NUMBER D 5 ROAD NAME <br /> �PF-IA ✓ 384P389 5a417-37/q/8w O <br /> LEGAL DESCRIPTION(see tax receipt)c--; 1 /8`�2 9'00/110 s4a iQa/ -13 <br /> Sof <br /> �i <br /> y <br /> � � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTUREJ //�ADDITION C �-- <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 `— <br /> y <br /> STRUCTURE/ADDITION USE:r/fe good 57agg � <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) 'a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. X C <br /> DIRECTIONS FOR PLOT PL?N DRAWING: (AERIAL OR TOP VIEW) T l�_1 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn _ O <br /> NORTH(N). f/► 00 9 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m p <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- V.t <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE g ° l <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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. -0 0 r.- �0 a -0 <br /> 6. <br /> 41 w o <br /> 7 <br /> fi <br /> . � i <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS c i rn <br /> A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this Information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d O <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. -n <br /> m : <br /> m : <br /> SIGN HERE 7—y7 <br /> (31 076ir bu ntractorI (date) <br /> ZONING ADMINISTRATOR <br /> uNPoa�oo <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 0 <br />