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('Oemf <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -a 0 z <br /> APPLICATION FOR LAND USE PERMITS 3. 9j <br /> - r <br /> y O <br /> a <br /> �L 1 C <br /> OWNER i LQ.lSll1 �' �f"�'\NA TELEPHONEC--( IcJ�d _ '"7 a <br /> o <br /> HOME ADDRESS 1`J\ \`(�,�t 1 \ �f1 �> �Q t �' ' II "y ► �I I/l" v U <br /> y ICAC, l l `jj J Q <br /> r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 <br /> 5P-1 ��fl/ 17 58y/jcj?_ _ <br /> LEGAL DESCRIPTION (see tax receipt) S [r 31/R\8 k SSU <br /> a 3l- lIs O I-O bUk20 C 9c�5 G1 to CD <br /> St k 5Gfl (' lc ( n - <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE St2ir 'a ADDITION ' <br /> CL < <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION m <br /> c 1 <br /> m <br /> �f��r�s �-Ke ° <br /> STRUCTURE/ADDITION USE: —t� C � <br /> w <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 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _n — <br /> O = <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O m <br /> n a <br /> -VZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Tm o X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH (N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <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. 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE0 J <br /> ISSUED. 0 /t1 <br /> If <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° <br /> I <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. <br /> W iu v v m <br /> 6.7. no4/ J9�Jt it 0 <' 3 � cfDia� m <br /> O ���[y� � � ' CD 0 � o � 3 <br /> O <br /> MOR <br /> cn <br /> I declare that this application (including any accompanying sc le) ha ,x4)ni y me and to the best of my --rO <br /> knowledge and belief it is true,correct and complete. I ackno a that I am responsi6litcr th detail and accuracy of d a : C <br /> CL <br /> all information contained in this application(including any accompa �) d I further declare that I recognize m m <br /> that this information 1 am providing will be relied upon by the Count/ tt i4,cc�di�7yjirgatermining whether to is- �? p <br /> sue a permit. I further accept all liability which may be a result of the County)of Bp�nett re1yin6 on this information I am m <br /> providing in this application. I agree to permit county officials charged with admnisfering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> CD <br /> SIGN HERE ' 1�//�t —�Ij—y d' <br /> ti <br /> (signature of ownerorbuilding contractor) (date) <br /> ZONING ADMINISTRATOR �J1 Mlcl(AV E E ? E <br /> t» v+wt»t»cn� <br /> N N (nNN01N <br /> Oi Ut O fT Vt O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />