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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v o 0 <br /> APPLICATION FOR LAND USE PERMITS � . <br /> • erN3/nl oto (�`S�Sozz � 0S. <br /> m <br /> OWNER Q�V m�� �' L�^� TELEPHONE (Cc (eq y'SyZi v <br /> 1 <br /> HOME ADDRESS 2 1'71 Ussr (J( Av5u „ wpAwLf m" , .. <br /> EMERGENCY/FIRE NUMBER 0 C) 3 1 ROAD NAME SU,Oty <br /> ThAr PR2r OF N N 2- � T7f$ S'1r <br /> LEGAL DESCRIPTION(see tax receipt) 45ZCTICW 2S TCYW- S 39 N ca= all 14 W r w <br /> tV ,04RwN1At#1 Ct+fFNArEL uyrg 4 <br /> y <br /> ANwrfF uu ataf�5ll�J • o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING QARsrk9l�ACCESSORY ST UCTURE DDITION a = <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> W <br /> m <br /> STRUCTURE/ADDITION USE: tj Pf fif <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) T <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) fic <br /> -n a <br /> TO Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 :b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS S <br /> MUST BE SIGNED AND DATED BY THE OWNER. o f t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEq ° W <br /> ISSUED. = <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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 PERMITTEDI <br /> 5. n/o !f/q--fei-- O't /lCir,.b/r1 'tal M In <br /> b 'Oe Cdw�.ri7"`9.l J <br /> � �Q� n V /_ / n- / Xvf� rRppDo � <br /> 6. `'"`_' l;.p!'���la Y'O1�Y�•�rt $'f'�'`rnal S�GI.c•� . �O 3 a His i s M <br /> a = <br /> a � mcHfOo � 3 <br /> 7. <br /> rn: i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ip <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : 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 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. 1 agree to permit county officials charged with administeringeounty ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time fbr the purpose ofins -n E E <br /> 0 <br /> SIGN HERE <br /> (si at re of owner or b ding contractor) <br /> JCl'C`L1daT O IW <br /> ZONING ADMINISTRATOR H 44 H 4ft <br /> S --- N NANNN L"(T <br /> _ N NOcn!G OO <br /> 0 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />