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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 /> F 0 <br /> � m � <br /> OWNER �E.1-N`L TELEPHONE <br /> � W <br /> HOME ADDRESS ��� - UJ - Q� �..�ev 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME ^ o <br /> LEGAL DESCRIPTIONt see tax rete! � ` 7 , <br /> ( p) VowML 1.( G S 2cnCD <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION �ir <br /> CL <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> cn <br /> W <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) TCD <br /> i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _n O <br /> x H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 M <br /> CL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m (� <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 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS P <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. zl�V4 <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 <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 S <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <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 0HWIo4 OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICA LY PERMITTED. <br /> 5. Gaffs IUB'?t> hr /n� p�liCed7Qa1`SC�c�er f'},�A— � <br /> zvc) m oov <br /> mZ �m of m <br /> 6. L,. �j, 62 A�1e�,5! CO - r.�r� Go � �. e n N 0 " <br /> ." mcg . � 3 <br /> p NCD <br /> 7. \�v o : � E <br /> rn : m <br /> I declare that this application (including any accompanying schedule) been ned by m the best of my c c <br /> knowledge and belief it is true,correct and complete. I acknowledge th m responsibl tail and accuracy of o <br /> all information contained in this application(including any accompany! edule clare that I recognize j m m m <br /> that this information I am providing will be relied upon by the County of rne� ermining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County drBurns ying on this information I am m <br /> providing in this application. ee to permit county officials charged with administering county ordinances or other m <br /> authorized person to hqye4ccess th t ov.p described premises at any reasonable time for the purpose of inspection. -n <br /> CD <br /> i M : <br /> ' : <br /> SIGN HERE S �� <br /> Ii atu a of owner r b Iding contractor) (date) <br /> ZONING ADMINISTRATOR cn <br /> N tT N N OI (T <br /> fT (] O (ll O, O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 o b o 0 0 0 <br /> 0000000 <br />