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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Admini trator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> -� r <br /> L .. <br /> OWNER ��� �"�f�jyffL TELEPHONE ��,2- 6 1!73o <br /> HOME ADDRESS ��2Z 8 GOOD 'Vl,fZJ 4 — /V,,eT1f- 61fW V07t XV, f �w JiLy <br /> EMERGENCY/FIRE NUMBER ROAD NAME 7-,Af Aa- <br /> Sc,o � � <br /> LEGAL DESCRIPTION(see tax receipt) (� 3 l S�j ) �/� �� " Y c <br /> 3 �— SAO—/ <br /> 0 <br /> y 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING �GARAGE/ACCESSORY STRUCTURE ADDITION <br /> v <br /> a <br /> a" <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 (`h <br /> f7�r7c C,s 51�1,� '- <br /> STRUCTURE/ADDITION USE: p` r ^ <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) y v 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) r � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m jD <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y .. o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rn a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, c <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 S <br /> MUST BE SIGNED AND DATED BY THE OWNER. o' o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 3 S, <br /> ISSUED. .. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <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 /> 5. <br /> 3 a M <br /> a <br /> 7. <br /> =crm <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS c ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of a i <br /> all information contained In this application(including any accompanying schedu further declare that I recognize m m : m <br /> that this information I am providing will be relied upon by the County of Burn¢ftl s ether to is- O <br /> sue a permit. 1 further accept all liability which may be a result of the Coun I I i*lam <br /> providing In this application. I agree to permit county officials charged wi dminis nMI 1 0 other ; m E <br /> authorized person to have access to the above described premises at any nable time for the purpose o ction. -n <br /> CD <br /> AUG <br /> SIGN HERE - <br /> ( f ow r or bu g contractor) RNETT COUN(data) <br /> s gn� <br /> TY <br /> ZONING ADMINISTRATOR �i(1� 'I��G Zowv W N W H N w <br /> N N U 1 N <br /> P PP5n V7o <br /> TOWNSHIP PERMITS MAY BE REQUIRED 00000 <br /> 000000 <br />