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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0z <br /> APPLICATION FOR LAND USE PERMITS��3 y�65�� a. 4 <br /> 12 (- 78-5•'784'�ay r tt <br /> OWNER DeH L 0 I S•Oh TELEPHONE 6f 2- V <br /> ��5 (73�-f776 eve m � <br /> aka �o 16 Bb ohej. ry �PooNe bu.s c <br /> HOME ADDRESS P1.rv%g,.r„17- 3'13y oXr-cM CitZel-F f, 0V06V-A4 ✓f+A/ ST"Y21'— <br /> CD <br /> p/ Q o <br /> EMERGENCY/FIRE NUMBER ( g O (rte ROAD NAME <br /> DoT 3 CSM V 2 P 117 <br /> LEGAL DESCRIPTION(see tax receipt) Sc 14-10 Sig /T40/fRjyW 2-40-/4-/4-0 02�3010CA <br /> C <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION o. <br /> a D <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION— <br /> ca <br /> ca <br /> STRUCTURE/ADDITION USE: ��7 S24SOn 160rc4 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 70 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> T s� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m N <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <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. qj <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. c i <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 <br /> ISSUED. C) <br /> l <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c O <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <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 /> P NDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> -P be- Art leasr5,1 Fbrrl A 0 r.- v v -0 <br /> s. tlJ('.� Pi t ah Z/,y Or`f1u/71 CJ's L-AJce �` a a Q Imo <br /> ,� A � �/' `� �,1 fJ �j e0 co <br /> w > > <br /> 7. H�UGT�J�f /�N IU Pi�CCC.► �'� �U� 6� Il4�u� �NU �ll`�L �ZuI c ' w !of: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best o y I '• p <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i m S <br /> CD ; i <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Ca <br /> CD : m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- m i O <br /> sue a permit. 1 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. I agree to permit county officials charged with administering county ordinances or other <br /> authorized pars n have accesp to the escribed premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> SIGN HEREvlr— <br /> r <br /> i ' <br /> (si atu of owner or ull ng eonVaetor) -' (date) <br /> ZONING ADMINISTRATOR <br /> HhhHu�� <br /> N Nut N NN (T <br /> ;� � � ut NONf7iOO <br /> TOWNSHIP PERMITS MAY BE REQUI fa''1 _ 0500000 00000 <br />