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po <br /> cnco <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator V 0 " "i <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> .. o <br /> OWNER J t( f " Oy1 "�c�' e3- FL)� O+ ti2 TELEPHONE S _ �, <br /> pp 7 /� m <br /> HOMEADDRESS j5((�(� C� C� q' �� 0 <br /> v r <br /> EMERGENCY/FIRE NUMBER ROAD NAME7A S <br /> LEGAL DESCRIPTION(see tax receipt) �7 c/ C �I (�(cty�y �_ o <br /> Ln <br /> r �r0 <br /> J �^^O y 7 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE AD XON a � <br /> 06 <br /> e, <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> y <br /> � �l <br /> STRUCTURE/ADDITION USE: n / T (il r <br /> (Home/Cabin;Commercial iness; Bedroom; Deck;etc.) v i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR it <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> �I 3• L <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> n FLT <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 C n <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M <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. <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 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � vel <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. Cr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c ry� <br /> CONDITIONS OF PERMIT: , <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. CA <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 /> ;aM0m a a -0 <br /> 6. � ann � <br /> v : 00 (20 <br /> o : <br /> Ca <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ` C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m : E ' O <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 of Burnett relying on this information I am 03 ; <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other i m <br /> authorized person to have access tote above described premises at any reasonable time for the purpose of inspection. -n�// / m <br /> SIGN HERE t Nel-IC4�7 <br /> (sidwre of own r or building contractor) (date) <br /> ZONING ADMINISTRATOR 40 <br /> W iH fA iN fA fA� <br /> N NUi N NN� fn <br /> Vt in OiIINOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />