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1C <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v Oz <br /> APPLICATION FOR LAND USE PERMITS a <br /> r <br /> I 7� 8 <br /> OWNER h U Ue_rk Q 1, _ L TELEPHONE <br /> HOME ADDRESS l '� h `r Ci(mow 1,`j 'M/1, [_JI, Sq S1 O <br /> r o W <br /> EMERGENCY/FIRE NUM13ER ?C3 Cf ROAD NAME <br /> / <br /> LEGAL DESCRIPTION(see tax receipt) ! 4 scsse,�J ,4 t 1 P' m(Unk,i2a .l ra G <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUREADDITION C <br /> 0 <br /> Cr C <br /> CL <br /> 5. <br /> TT <br /> 1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> N <br /> _y,, f <br /> STRUCTURE/ADDITION USE: �1�-'r��-��Q �� I D.I YQ.D lir <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) `c <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED, m 3 W <br /> a <br /> DIRECTIONS FOR PLOT PLAN nRpwtnlr,7 (AERIAL OR TOP VIEW) T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m Fd <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m N <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <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 HCl <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. c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q o <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> Z i <br /> CONDITIONS OF PERMIT: �0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( fi <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C-N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C <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. p <br /> 5. To .h e 4.Sco ,54orcL f C, ,4, t�� �i O OM <br /> 6. 2O 3 niu �n ; <br /> 7. <br /> two : �m <br /> o <br /> =v+: 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 im c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ' o'w . m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Ai i <br /> p <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 d <br /> providing in this application. I pgree to permit county officials charged with administering county ordinances or other <br /> authorized person to have a s to the above descr remises at any reasonable time for the purpose of Inspection. <br /> SIGN HERE <br /> ( gnat re of owner or II g contractor) ( ate) <br /> ZONING ADMINISTRATOR <br /> iA h ) N <br /> �/� t7+ N , N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0000 <br />