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0"YL <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITSCL. <br /> N <br /> OWNER F� �� 4S TELEPHONE 4M q21 <br /> 2 <br /> HOME ADDRESS 3QJ ad yen LGQe� <br /> EMERGENCY/FIRE NUMBER a S'o1�y ROAD NAME rUl�n deiSiSu <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) S a 3 i zle Q��W �G/�✓ �•YJ� L, �j <br /> c <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION Q <br /> o. <br /> rn <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> y <br /> m <br /> / <br /> STRUCTURE/ADDITION USE: LrYA 4d'4A r, n4/a QN<Q 4/��1 �D /1 / <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER, ANY INCOMPLETE OR 3rD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS (NB)AND INDICATE In <br /> NORTH(N). y ` 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, S Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> q � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a <br /> ISSUED. �. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o CS <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. I <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 SP CIFICALL PERMITTED. rt / n `�, n <br /> 5. Sem 2//h� L X165.3 ( / C�r. O OF <br /> 6. 9`� CL CD NCNmo = 3 <br /> c <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best ofmy (j C <br /> I' <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Q l o <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- y 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 acgetp1to the above described premises at any reasonable time for the purpose of inspection. T <br /> CD <br /> SIGN HERE � <br /> (sl a re o!p a building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> riK)0� <br /> N N Ut N <br /> (lN O V7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />