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6-Y) c3 <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator � ° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> M 0 <br /> w <br /> CL <br /> c d� rh <br /> OWNER -DAN # L lnI DA 'B(,#-r zi5je TELEPHONE <br /> HOME ADDRESS i A(-r /Q OSB)/ �� t A� ��v� � "C"*✓ v <br /> ,?`k5jR 6A--�lJ Po Sro <br /> EMERGENCY/FIRE NUMBER Sy^^Q f ROAD NAME <br /> � r <br /> LEGAL DESCRIPTION(see tax receipt) sa T 38 g ►:%W PGL /N GOVT LOT G� - <br /> o) 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION n <br /> J Rr��„�i.Jy ►►ALS ra/f6�+c nCg� w+tN� o: <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION uJ <br /> st6r <br /> STRUCTURE/ADDITION USE: 'U'h�— -i <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 0 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> x c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a 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 C — c <br /> NORTH(N). fn <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m z <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, c <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. 64 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 a <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE g B I <br /> ISSUED. <br /> Z � 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <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 /> 5 PONDS, RIVER UNLESS S�PECIFIC�LL1 PERMITTEQ. ()k, ��� kQ � � ,�, ;0100r, <br /> 10 O r, �D k o la <br /> Iem�-fi 1 'th)�1``" _aa I° �J w o 3F 1n <br /> 6. co v � ` �w m <br /> Z : ° <br /> 7. _m: m <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 ; ; , <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> 0: O <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information 1 am E o+ : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. - , <br /> L3 <br /> SIGN HERE 5!( to u{ <br /> sign re of caner or building c tractor) - S� _ _` VVV <br /> Ihr7Y'7,7 <br /> 40 40 4W <br /> ZONING ADMINISTRATOR Nw NNw <br /> 1 ( N N1 fT <br /> I II✓ Al Al 0 An Al 0 0 <br /> 0000000 000 <br /> TOWNSHIP PERMITS MAY BE REQUI I D <br />