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1903-PN on Cr-nr\,o <br /> BurnettCounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> r <br /> w 0 <br /> w <br /> c <br /> OWNER D TELEPHONE `.;? a �;g <br /> HOME ADDRESS e: <br /> EMERGENCY/FIRE NUMBER a� ROAD NAME.5,IV <br /> 1 ( <br /> LEGAL DESCRIPTION(see tax receipt) j> &5 4Z>j-3 Z41 &/p//S- / !36 i� y <br /> TYPE OF PERMIT(S): DWELLING/BUILDING--)�_-GARAGE/AC ADDITION it <br /> L1 <br /> 5. <br /> SANITARY—) PRIVY FILLING/G DING CAMPING UNIT SUBDIVISION o'� <br /> 7, <br /> fi n b'['` �/✓ 3 X <br /> STRUCTURE/ADDITION USE: -� V ,K <br /> (Home/Cabin;Commercial Business; Bedroom; Dock;etc.) a Uaa) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 1 J <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p ^' C\ <br /> �l <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0S V 'q <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M n <br /> NORTH(N). N 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m o <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, SCJ Z <br /> STREAM OR RIVER. ! P <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. c ` <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 ° <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 00 <br /> ISSUANCE. S� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS,RIVER UNLESS SPECIFICALLY PER ITTED. I ��fI <br /> 5. ��ru�z b ld�t ,.fit e�S -� fva x �a�e ?��J �r��r� <br /> ;Uv 0; vg° M <br /> ' a2M <br /> s. <br /> .. <br /> 7. Z : " "� <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS ; C <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize (D 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 v <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 app on. I agree to permit county qfficlals charged with administering county ordinances or other <br /> authorized personffihagoss to the above desqribpd premises at any reasonable time f i <br /> SIGN HERE <br /> (sa r6dj6miner b Ing contractor) �' date) <br /> ZONING ADMINI RATOR 1 0 ( ' ` : ` ` w <br /> WMM(ANiA�c� <br /> Vii uul O uul 01 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />