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Burgett County7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator o c <br /> APPLICATION FOR LAND USE PERMITS 3 �j <br /> L� <br /> \ w ° d <br /> OWNER DIAI011E NIe kSOd 1 AeWA4 E PAK AI TELEPHONE ��oIZ-1 $Z2- CL <br /> 522 <br /> Q I l I near�o XI ` c� 0 <br /> HOME ADDRESS 4101 81QISde.11 Ayenut S. Mi 15, !,A^,W <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME IMW�6%'> L0.^4. <br /> $51 3`K <br /> Sa, Tfoalw Actes 1.530 <br /> LEGAL DESCRIPTION(see tax receipt) Ra;nbov�l L loft 2 2.-Ifo-U.-39-0 .012-M n <br /> o <br /> �( S , Q <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/AC�ESSORY STRUCTURE /` ADDITION a <br /> $(INK Hop.% •f•LAK00oite STr)taa�Y s. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: lir <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) 'a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c <br /> 0 <br /> -n 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 <br /> NORTH(N). N <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES, (B)BUILDING(S)TO m 7\- <br /> CENTERLINE <br /> CCENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. 0 <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. N I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a ° <br /> ISSUED. o' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c ) <br /> CONDITIONS OF PERMIT: Im 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 /> P NDS, RIVER UNLESS SPECIFICALLY PERMITTED <br /> 5. Vf,� w be ,� Tu lvl r 52{bo� M M 0r <br /> s. .. � 6P I�tAc't -C ►" ' se c( � � 111 L9 <br /> 0 � 3 <br /> c}} ,_, 11� � __ �} 1_11' wHo oma <br /> l OUV�- t��e, J1l�r`Ll o f m <br /> 7. _vl; <br /> : m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my a5 C <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 CL <br /> e : : 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 he above described pre 'ses at any reasonable time for the purpose of inspection. i <br /> m : <br /> 521, 97 . <br /> SIGN HERE <br /> (date) <br /> gnature of or buildicontractor) <br /> N w w h H HZONING ADMINISTRATOR N ONNN <br /> (J N t T <br /> V1 UOw UOO <br /> O <br /> 000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 00 <br />