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OfL <br /> Burnett bounty 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator - c o <br /> APPLICATION FOR LAND USE PERMITS 3 N <br /> N 0 <br /> mC <br /> C <br /> OWNER SA,1M�� L i-�OGrC�- TELEPHONE 7115- 5%D02- :542.4 NO rJ <br /> n A O <br /> HOME ADDRESS GOO LAVN�jQQ►J �4V� 5Qqee\0e. W1. 548SO <br /> EMERGENCY/FIRE NUMBER ROAD NAME E R,Aes Lbt<% E0^9:0 I ~ <br /> po.czc�L- ►► o o 5 o 0 o f r U <br /> LEGAL DESCRIPTION(see tax receipt) 1(>01 O F $ 400 GoJT, Loi' 2 Cl) r <br /> e <br /> ti0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION cr 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 03 <br /> TO2 � Lx. <br /> Q > N <br /> STRUCTURE/ADDITION USE: S lA <br /> � ,Lc>t�G <br /> � r � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v p <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 Q A <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n $, <br /> �r o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m $ CJI �3 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn 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 1 jJ 0 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, O 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. fJC�Ji <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o Y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> 5 b <br /> ISSUED. St <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o N 0 <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 /> PONDS,RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. M M 0 o?oT <br /> �p L% M6. v � v Ca °1o3ic <br /> 91wo �ro <br /> 7. <br /> =rT: <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ii E <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize : m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other S <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> L5 e <br /> SIGN HERE ovym <br /> gn tura of oww lirtjucko contractor) D (date) - N: <br /> �f E <br /> ZONING ADMINISTRATOR OH M w N fn N H <br /> QN on N NfTM <br /> . ,:it NNOpI (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIR 0 0 0 0 0 0 0 <br />