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QYl C ry <br /> Burnett,County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator a o .oi <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> r <br /> t� 7 J//� G/2-3s9- 352.E Lw� <br /> OWNER.ToAj /r/. DG- e,rw y -I-gN^*LEPHONE 6t2- 966 , j 6 -;7 ovN j ' <br /> MPcS) 664fV -inJ1r0 , /p✓�f. Sa. - iG,viO, Mv• SS�23 <br /> HOMEADDRESSeLAi4�� J14)6 Srv^_ 1,0je- ,F leo. �RIN$�/�y, ws. , 4. .&;7 4 <br /> r o <br /> EMERGENCY/FIRE NUMBER ROAD NAME 5;rVvL64S <br /> �J ✓ 'T. Lo }r j 5CGT/D > TowNf; F aw 4-1 <br /> LEGAL DESCRIPTION(see tax receipt)/Jo P �� , /��Li 6 /S W6-$7'+ d oµJAl S /V l`+ 00C 5W1"s <br /> �/ 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE XADDITION �Q <br /> Q: <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: 2 is X .32. ' aR4jq4d- 0 <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) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 'c <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M n <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 v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. c <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. J <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. v �) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE S <br /> ISSUED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I (I <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ll <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 /> It <br /> 6. .'� v Cit 60 uNiwo = � <br /> 7. o <br /> —_v,€ i i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the be of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a 9 E S <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize m m 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. I further accept all liability which may be a result of the County of Burnett relying on this information I am d <br /> providing in this application. I agree to permit county officials chargeddmin teringcounty ordinances or other E CD <br /> o <br /> authorized person to have access to the abo mases-at any pection. -n <br /> SIGN HERE <br /> (signature owner or building contractor) MAR 1 7 1998(date) <br /> ZONING ADMINISTRATOR ` ` ` ` ` ` H <br /> -_ • NHNNNN� <br /> BURNETT COUNTY N N in N N N fn <br /> N t7i O V7(7i O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING 90000000 <br />