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C/!'71111 inNw' <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 64872 Office of Zoning Administrator 0 o 0 <br /> APPLICATION FOR LAND USE PERMITSDj <br /> 3 4 <br /> r <br /> a o <br /> w <br /> OWNER �Ame bora t.� TELEPHONE 6 rA2 _ 4/S9- 7S/r� o <br /> HOME ADDRESS 510/ SLI,' ALE s L_z7r_ l�� / <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> ,40CSM V / ('80a �O.rrn-tr( <br /> LEGAL DESCRIPTION(see tax receipt) /�/1r �li+k (,�, 5 S Cj 06v d ca <br /> V) 8 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING---X—GARAGE/ACCESSORY STRUCTURE ADDITION ii <br /> cr <br /> 5. <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> f` ca <br /> STRUCTURE/ADDITION USE: C How r- c E <br /> (Home/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. m »_ <br /> DIRECTIONS FOR PLOT PLAN D AWIN 7 (AERIAL OR TOP VIEW) O m V" <br /> n a <br /> ?I _ 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). c n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rrrl �3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, ) 4_1L Z <br /> STREAM OR RIVER. 0 <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. 64 <br /> IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> v � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEq o I <br /> ISSUED. 6a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � C <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 0j <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. f lkr�Q NGQ. OZ- Sf.Z+w�j'i.(oti 6e /', 7zA ee, <br /> 6. J�.-ll �KS�ost>� �y.,-tao�{ /t+�-sem {"a ,/i.z. ,SePsIFE-1 �/Ylk-�C.�.QI.� �M�rjra'Ct� /-� " m 1 n m <br /> � 3a wQ= Z <br /> . a wwp'53 <br /> w a o Baa <br /> 7. �Ir S�f c ulcs P-ACL� �zek,'4 L'ZA-l�s"�f it Ae �`��os� lkop- .S-e7 o Cn M <br /> m <br /> I declare that this application (includift any accompanying schedule) has been examined by me and to the best of my or p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am res n <br /> 9 p g responsible for the detail and accuracy of c , <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 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 p <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 m' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E m <br /> authorized person t9jhave access to the above described premises at any reasonable time for the purpose of inspection. m <br /> COD . <br /> at <br /> SIGN HERE <br /> (s na re o owns wilding contractor) (date) <br /> c i <br /> ZONING ADMINI TRATOR <br /> w�nerwfnfA <br /> N NNNNEn V7 <br /> N V7O Vt V700 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />