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L�)71 CAvnp, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator I o <br /> APPLICATION FOR LAND USE PERMITS ;W � yj <br /> OWNER R l c H PFRJ2 + QLD ENR FL <br /> t� ry TELEPHONE 6 ��_ �3 —93Cg V a <br /> HOME ADDRESS130 / 6 m �� E 1 ST �� �� I�� N 5 7/ ` AA,, go <br /> X W IW o <br /> EMERGENCY/FIRE NUMBER 7 q A ROAD NAME E N I R R N CE: /:?D <br /> Vl i-LRGIr- of Yu i-oi�V �HK� f <br /> LEGAL DESCRIPTION(see tax receipt) ASSES D R rs LbT 1 SLK 1 <br /> w <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION_ n <br /> S. 17-1 <br /> Is. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> ca <br /> STRUCTURE/ADDITION USE: O IYi E <br /> (Home/Cabi ;Commercial Business;Bedroom;Deck;etc.) O vo <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 a C� <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m ;b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE � .. o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, o-Qo <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. <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 /> v 's <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q ° <br /> ISSUED. °' C} cN <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 ( Q <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 /> /PtOAN,D�S, RIVEER` UNLESS SPECIFICALLY PERMITTED. 'FV-4, <br /> . ✓l 1 <br /> 5. !".rnc^ le65 �d/U d� CU�n. `Tac�`,na lk� Uu7it� m <br /> n. M '0 <br /> m m p�q <br /> a C=L ;g <br /> 6. v' : 9Crl `" oma ; <br /> •• : Iwo : Bio <br /> z : �^ a,� <br /> 7. c CO 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 ` , ;a <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- m <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 ti os of inspection. ,� <br /> — of <br /> SIGN HERE 11 7• /rr.�r'"�'� r`. '�� /� �: <br /> ai onature ofAwner or building contractor) ! (date) <br /> ZONING ADMINISTRATOR i . <br /> N <br /> I (pNMgN incn <br /> 1 N N En I N N°in N <br /> V• q,0(INCG <br /> 0 0 0 0 o co <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />