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� C-)ILP, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER ifs;L �EGsreA•�� TELEPHONE ! ) 1,36-6098 c <br /> HOME ADDRESS 1534 /9� AVE u VJ 5%.Aver , /111V SS//-4— <br /> EMERGENCY/FIRE <br /> EMERGENCY/FIRE NUMBER 3 i 3 ROAD NAME <br /> 1 <br /> 9c- 19-9 (4q3/4( 500 1:5-70 S1q/T40R14W <br /> LEGAL DESCRIPTION(see tax receipt)Ae.ReS . 0o pCL44 401 qj0 80Z700 (,0t/ Lo-r 3 w <br /> Ca <br /> rA O <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREyADDITION a <br /> 5. <br /> 5". r <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: O IC 7LOjN � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) .0 <br /> T o 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 C O <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 3 <br /> P <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <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 i <br /> MUST BE SIGNED AND DATED BY THE OWNER. m ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. <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 <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 /> 3 m Qo o m <br /> 26 a 3 <br /> s. RCw ,m � <br /> z : " <br /> 7. <br /> =N� � 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 <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize ° 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 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 a m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to h v access to thp above describ&4 premises at any reasonable time for the purpose of inspection. T <br /> SIGN HERE` <br /> Ig lure of r r bui Ing cony r) A") <br /> I <br /> ZONING ADMINISTRATOR SEP <br /> uwww M <br /> N NOON Ill <br /> PP . N pp <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o 0 0 0 <br />