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cYb C'6- . <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator - i; o <br /> APPLICATION FOR LAND USE PERMITSCL <br /> 3. <br /> OWNER � � C wP*3�N TELEPHONE 6(2s M--6157 <br /> HOME ADDRESSt�kxlbtk�k- <br /> 0 <br /> EMERGENCY/FIRE NUMBER �OZ�Z &SSZVFAAROAa NAME <br /> � r <br /> LEGAL DESCRIPTION(see tax receipt) ZZT 4 CSM \/EL. ri <br /> 1 � <br /> Co o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ CCESSORY STRUCTUR ADDITION Q ' <br /> n <br /> SANITARY PRIVY FILLING/GRADING 'y—CAM`PI�NGCUNIT/��?7 _SUBDIVISION � <br /> STRUCTURE/ADDITION USE: 5'-m e��/ f o —roe, /t t ym <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> .� w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 1 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y G- 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, Z <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. 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 c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I J <br /> ISSUANCE. O <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. /J <br /> 5. RppR <br /> AM <br /> 7 tb" M.a m <br /> 6. Rig CN '.' > > 'Z <br /> 7. o x <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of c E <br /> all information contained in this i will a lied u n an accoo an f s e i r¢tfat o nize e B <br /> PP (including Y P Yi 9 9 m <br /> that this Information I am providing will be relied upon by the County of Burnt <br /> ISS4,12, <br /> e n <br /> sue a permit. I further accept all liability which may be a result of the Coun t I i n I am m <br /> providing In this application. I agree to permit county officials charged <br /> IV <br /> ministering county ordinance ar other m <br /> authorized person to have access to the above described premises at any re able ti r the a of i pection. .n <br /> ml- <br /> m : <br /> SIGN HERE li <br /> ure of owner wilding contractor) RNE ) <br /> ZONING ADMINISTRATOR ZONINGJH <br /> NIo,n O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o' o 0 0 <br />