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eACbT\P <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 64872 Office of Zoning Administrator a o 0 <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> ^ r <br /> ' y O <br /> N <br /> r /1q C <br /> OWNER Vey ct_!t✓�- L dry Co LTD TELEPHONE 'Z(S r'�� 3 / I O <br /> m <br /> ry 1r 1 <br /> HOME ADDRESS Z p�S I F-r lam- `VRM r3f) sy <br /> //�� �r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME -I� &iza6Af Lok Ur <br /> V-w Vilaak 0 q 44^ Gr"A l To 4+ I <br /> LEGAL DESCRIPTION(see tax receipt) $LAS, g `�� # Z3 s zq u) <br /> 8 <br /> v <br /> Cn <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-,K-GARAGE/ACCESSORY STRUCTURE ADDITION v <br /> a <br /> 5. <br /> E. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> C G <br /> STRUCTURE/ADDITION USE:�T"` /TL6 wytiorc_ . <br /> (Home/Ca in; Commercial Business; Bedroom;Deck;etc.) 'V <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR _n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. PLAT__ �p Q n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 5eE � �`'"//`��� 'Ipp�LL � � 0 _ <br /> �OJ l 6, �hap"s r o .izo <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 .F <br /> NORTH(N). ca o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <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. >"o <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> V <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE `"N ° QQ <br /> 5 v <br /> ISSUED. " I l <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c Q <br /> CONDITIONS OF PERMIT: w U) <br /> 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 /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. :See &Aar� Arm i6 /0�5?0J �' �- � <br /> a : � No !^ g3. 3 <br /> 7. o F IS 1 <br /> __y <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my E 65 O p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i a is C <br /> all information contained in this pplication(including any accompanying schedule)and I further declare that I recognize m m E m <br /> that this information I am prov Ing will be relied upon by the County of Bumeft Wisconsin in determining whether to is- m a <br /> sue a permit. I further accept#11 liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this Iication I agree to permit county officials charged with administering county ordinances or other m <br /> authorized pars n have aAcess to the above described premises at any reasonable time for the purpose of inspection. m <br /> r m i <br /> SIGN HERE 1C.6 t6FI(;;1 L51cf' 3G s <br /> ( gn re of owner b Ing contractor) ( fi) <br /> ZONING ADMINIST TOR _ <br /> ALZ ` fA fRNH(H fA� <br /> jY� III INJ, ,(N71 O(.NT N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED `,kl) ;: 0 0 00000 <br />