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pit <br /> Burnett County 7,410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator of 3 <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> vr <br /> a <br /> OWNER e1MtS S� 1-�`I f'♦ �^ ^�— TELEPHONE 612, SI� 0l.f./l/ a <br /> /1 111I �A,�l <br /> HOME ADDRESS t-104U Z2n 2i p2 h �n ` hMo 4 rl )./ wug& <br /> r e <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME L� i ( L <br /> Ut Plrti <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) �o l- 13 �y l N Cs S S7 �'1 S �f'W✓P C <br /> rL)lj <br /> 0 M1 <br /> o � <br /> rn = <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> a <br /> r <br /> SANITARY PRIW FILLING/GRADING CAMPING UNIT SUBDIVISION 0•= <br /> ,n N <br /> STRUCTURE/ADDITION USE: 0.,z b t✓\ _22 'Y50 Vy a-t�l'�"' «o� )�o�7 Rll <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) 0i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> In ^� <br /> a <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 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn `. O <br /> NORTH(N). - 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO In v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 0 Z <br /> STREAM OR RIVER. <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. I <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. o <br /> o OO <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. SL i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ZQ <br /> 0 <br /> CONDITIONS OF PERMI 7d I <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 /> 5. <br /> 4A -0 m m lgDE�om <br /> 6. d6,� vC % <br /> St <br /> =m € [ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my : ; g '• ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ` w <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �� u e EE A <br /> M <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- m ; O <br /> sue a permit. I fuj!baLarcspt all liability which may be a result of the County of Burnett relying on this Information I am d <br /> providing In Wapplicatl6p. I agree to permit county officials charged with administering county ordinances or other [ o [ E <br /> authorized pe onto have 4ccess to the above described premises at any reasonable time for the purpose of Inspection. T ': <br /> SIGN HERE 12 19 0, a M ' <br /> (aign�aWre�of owns Ilding contractor) (date) <br /> ZO GADMI RATOR �Jl/n IGn . . . . . • <br /> MMMMMMN <br /> N NNN NUfa <br /> N fnOtn [m0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED c o c o 0 0 0 <br /> 0000000 <br /> Ur- <br /> SC'�Tr1(o <br />