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n cj-x� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3° <br /> - r <br /> `133 P <br /> OWNER O17¢/ ` a /20 h S TELEPHONEd,1,p � I. 2 -Lt-b1--2 <br /> HOME ADDRESS �eFL e O <br /> .� y in y s s 7�' 9.��r 9 <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER �� �� ROAD NAMEjs <br /> `f-7 tS . <br /> LEGAL DESCRIPTION(see tax receipt) S �tQ/(>'r 6 4Cf-Q-J (. 6 Pd <br /> co <br /> k:fd-n o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE`p I ADDITIONaADDITION <br /> c <br /> a <br /> H <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIO�N/ 0 <br /> STRUCTURE/ADDITION USE: Ca,' 4) <br /> fir <br /> 'fi ` <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) ! i <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. "*� .-. <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O <br /> m a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> n <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEa <br /> ISSUED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z C <br /> CONDITIONS OF PERMIT: ° _ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 71v <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4 NO STRUCTURES, INCLUDPONDS, RIVER UNLESS SPECIFICALLYPERMITTED.NG PE MIITTED.NG WALLS, TC.,ALLOWED WITi�II p�T� 7 HWM OF LAKES, <br /> 5. ((`JJ' �J <br /> 6. � cNNa ;ame 0 3 <br /> 7. <br /> MAY 2 7 1998 Z N '00 q <br /> — <br /> • v,p : : m <br /> I declare that this application (including any accompanying schedule) has be S �anS(tot st of my cj Cr : : p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am respon ¢¢�f T}fid accuracy of m Er i C— <br /> all information contained in this application(including any accompanying schedule)anYf�declare that I recognize m m <br /> M <br /> that this information i am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 amm <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other < 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> SIGN HERE <br /> (siig"�� of owner <br /> �or-building contractor) (date) <br /> ./ <br /> ZONING ADMINISTRATOR ` 1m �1{�(1I <br /> to to+n u+to w <br /> N N N P N 0 0 <br /> (r p1 O Vt,ut O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />