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CN-'� r a-YND <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator V 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O <br /> C <br /> 10 W -P 4-e 10 R�c.+r 715-b5� 319 / � <br /> OWNER TELEPHONE m <br /> O <br /> HOME ADDRESS S__730 3 L ACS —8C Pry <br /> EMERGENCY/FIRE NUMBER g��o ROAD NAME &A_CK 13 zl �- <br /> Y 3$s a8 4ba a/� �IucKPJ�arf+cr� trot/3 r <br /> LEGAL DESCRIPTION(see tax receipt) 5 17gr 1 R 17 M) -7 0 50• O 2 300 <br /> Co o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> o. <br /> 5. <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> N <br /> STRUCTURE/ADDITION USE: "owe. -6, r-i t r rise kwLsc, , Poi7 &s-R m j VtIC10r :Zel;� X-V. 5i <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n <br /> ?I Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m M C7 <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m (� a <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, ( o <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. o I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,'o c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> F <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 /> 7. o : y Z <br /> =� : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c E ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d a` '• C <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize w m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in dote whether to is- O <br /> sue a permit. I further accept all liability which may be a result of th � i rmation I am m <br /> providing in this application. I agree to permit county officials cha n i ces or other 0 <br /> authorized person to ve access to he above described premises at I r e o f inspecti n. n <br /> SIGN HERER 2 <br /> (s g-natu�re'of owner}orrebuilding contractor) ( atO <br /> ZONING ADMINISTRATOR �J(.iYl �1OniQ�) g 1RNETf COUNTY . ' <br /> ,J <br /> ZONING R,,**,"`"`""`"`"CM <br /> NNNN ci o <br /> N O N 6n <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 66666 <br />