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,�1 a <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator �/u a o <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> - r <br /> w <br /> c <br /> OWNERTELEPHONE S <br /> RoIlE/t'> lIAMEN TELEPHONE <br /> 0496/{7 �/� - ��o •-�9S`/ a <br /> or <br /> HOME ADDRESS 47 ,yiy up/°ER 9 j-7d0 <br /> MN .S" /AT, � <br /> � 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME CE pO f wr rgop <br /> Il 1N, � <br /> LEGAL DESCRIPTION(see tax receipt) I y <br /> voir. 01 Nur y o,! W sEc td o/r 37/V <br /> Or mer w /3H.e/vE 7T 7y. w/ �N <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITIONc <br /> CL <br /> 5. <br /> o' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION � <br /> V) <br /> STRUCTURE/ADDITION USE: 5 ilfifAC SfASeA SGiN Pp4c14 S7oRA1,'F 6 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _n <br /> O a LN <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S U I <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). ce 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m c <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- I <br /> INGS,ROADS, LAKE, LOT LINES. SO `2 <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 I �• <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. S o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P O <br /> CONDITIONS OF PERMIT: o '7 (W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT _Z ` V <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J(- <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. 3 Q <br /> 6. o. ' 1 ; <br /> 7. Z ` R 0 4 <br /> o : <br /> =y: <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 C) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C C <br /> all Information contained in this application(Including any accompanying schedule)and I further declare that I recognize ' m '. ? m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m 0 <br /> sue a permit. 1 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 the above described premises at any reasonable time for the purpose of inspactiop, Wm <br /> SIGN HERE <br /> (signature of owner or building contractor) I (date) <br /> ZONING ADMINISTRATOR ( Z h <br /> Hinwuw� <br /> i - N NNNN V,N <br /> N U 1 0 f r 1 N 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRE i' —" i 0 0 0 0 0 0 0 <br /> -- _ --_ 0 000000 <br />