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Cmp <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. s <br /> a (�- <br /> OWNER TELEPHONE <br /> - ' m <br /> HOME ADDRESS 427V S , Go I, Tzz� ' tIn f 14�)Z <br /> ci c ` W <br /> EMERGENCY/FIRE NUMBER 4621 ROAD NAME .. <br /> LEGAL DESCRIPTION(see tax receipt) S Ce S(Y", co <br /> y � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION GOQ <br /> n <br /> w; <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION � <br /> EAICL CSE 8Xi'Act <br /> rJ t CA 8. <br /> STRUCTURE/ADDITION USE: 7 Seflisc-%. Act k1� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �Gl[ f _ ���Q 0 e <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) G�//JJl}(ii�d tB7' <br /> T1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S �2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS ATE r_ n <br /> NORTH(N). 3 <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, b z <br /> STREAM OR RIVER. 9 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- I C> <br /> INGS,ROADS, LAKE, LOT LINES. `2 <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. S m o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEq 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: o O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITJ <br /> ISSUANCE. (� /�y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. V <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. <br /> c m G?a -04 3 asi ;M06 � c$ !" oS3 <br /> 7. o Viz ' <br /> _w i rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of CL <br /> y <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize o m <br /> that this Information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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�a other ; m <br /> authorized person to have access h ove des ises at any rea r ion. <br /> e <br /> SIGN HERE Gam° /i2G �ow6'�i <br /> (a rfitul of own o wilding contractor) A R 4 ») <br /> ZONING ADMINISTRATOR N <br /> NETT COUNTY <br /> N N O N N O O <br /> TOWNSHIP PERMITS MAYBE REQUIRED ZONING 0 0 0 0 0 0 0 <br />