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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator ao o <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 <br /> OWNER ell>2Gs"� ��Z'rj Gl/�� Z✓'� TELEPHONE ��_ y- I I g C (, <br /> O <br /> HOME ADDRESS (�Q,�' �fy L/!s L .� /27� GU'�G� <br /> 0 <br /> EMERGENCY/FIRE NUMBER O 7— ROADNAME p,!!�7✓ it f 4 <br /> LEGAL DESCRIPTION(see tax receipt) l l��'� Lr-,—) ��-j qo--�tj Y q n <br /> N 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION_ n <br /> 3. UPtt. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION— <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: }��� lz�`�'`� / � "�` 17 <br /> � 1 <br /> (Home/Cabin; Commercial B siness;Bedroom;Deck;etc.) ' <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR w <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) <br /> O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE imn <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m M <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> 0 <br /> STREAM OR RIVER. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- 1, <br /> INGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 64 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> 2. ° <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE g <br /> ISSUED. Y) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> P <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. CJ1✓1 <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 /> I/ <br /> Im <br /> 5. ��(716. 1'L " /`l 111 p� � ra R°yyo0' <br /> .? A <br /> e o S 3 <br /> 7. =y ' E m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my Lu [ 691 [ ? IS <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ' u ; 5 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize tri <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> e : <br /> SIGN HERE <br /> (signature of or Ing ctor) g 3e2 fatal <br /> ZONING ADMINISTRATORZo <br /> "CAN " <br /> ON <br /> In <br /> O O O O <br /> T WNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />