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Ct. <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O <br /> CD <br /> C \ <br /> OWNER �0 � P.0- 4 1"/oE>L TELEPHONE �� — ys/� 0 Q <br /> HOME ADDRESS 2P `'yf,Z," ,b f-• I�TGSJS't�J) ! = 0 <br /> EMERGENCY/FIRE NUMBER Z5 $ ROAD NAME <br /> I � <br /> LEGAL DESCRIPTION (see tax receipt) <br /> C o <br /> C <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION_' ' <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> r <br /> V) <br /> STRUCTURE/ADDITION USE: � A'/.S� 9`11g�-�•R / �J�G/C 04T <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR p n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -`� <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) �� O o \ <br /> n ` <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m ,�T 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, U Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- t� <br /> INGS, ROADS, LAKE, LOT LINES. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE o <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z rr�11 (Wc, <br /> CONDITIONS OF PERMIT: P CJ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Uj <br /> ISSUANCE. 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 /> 5. <br /> CD zvI CD Iov <br /> COD mco n a T. 3 <br /> m <br /> 6. a m 0s <br /> 7. o m m o 70 =i <br /> eco : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofn c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m 55 <br /> M <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 i on fr1^rtnation I am 'm <br /> providing in this application. I agree to permit county offic' charged w;h is i'� u ditiaQiD(es or other m <br /> authorized person Wave access to the above describe rem' es at any fe o� 5r� e���{{{{{{r of inspection. m <br /> mE <br /> SIGN HERE lkd wo/Z L o/L — <br /> ( PR <br /> gn ure of owner r c0tractor)c tractor) { (date) <br /> ZONING ADMINISTRATOR E ' ' ' ' ' ` to <br /> cn Fn cn w f»yr <br /> ZONING N N (l N N U CT <br /> V1 GO (INOO <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />