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51 `"" -Y ) <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator $ o° o <br /> APPLICATION FOR LAND USE PERMITS X. <br /> .. w <br /> m <br /> c <br /> OWNER < ,A]i,C ' n _ TELEPHONE 7�, jp3s 3 6 7y <br /> v <br /> n� <br /> HOME ADDRESS a� .�S� (� � V�t= "�7�y0r 01 <br /> 0 <br /> EMERGENCY/FIRE NUMBER a�p3s-0 ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) 1_0t to <,;ee SDN 15' Totortskajp <br /> r� e <br /> ca 7 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION n <br /> m <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> ^ <br /> f�77 y y <br /> STRUCTURE/ADDITION USE: e C' ® p� ` 30 / <br /> (Home/Cabin; mmercia usiness;Bedroom;Deck;etc.) V <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In 1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) A $ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'e <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C c <br /> NORTH(N). co <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> 0 <br /> STREAM OR RIVER. <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. N ) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 8 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ° (( <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c C` ` <br /> CONDITIONS OF PERMIT: �V <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT i <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. �, /, ga0L �e .4-r/00-b f 7TJ l _ 0n-r LV1n� v. a`rrC , ;a -0 0 r- v 9 <br /> Vm <br /> 30. Q _ 70 <br /> 7. <br /> rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? a <br /> Li m m; f M <br /> all information contained in this application(including any accompanying schedule)and 1 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- m ? v <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have apeess to the above d cribed premises at any reasonable time for the purpose of inspection. r <br /> m : <br /> SIGN HE �v <br /> (sl ture owner or 11 g contractor) (date) <br /> ZONING ADMINISTRATOR N N 44 A <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 <br />