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&/r cam , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator R o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 <br /> F <br /> C. <br /> c <br /> OWNER 7- .Q.4 SSE T T TELEPHONE a <br /> v <br /> HOME ADDRESS �yy� 4Q611Z�y 6, 0 <br /> EMERGENCY/FIRE NUMBER ,�dl V0 ROAD NAME �o�/X.tJ� v/ �e �• n 20 C� .°r. <br /> f <br /> LEGAL DESCRIPTION(see tax receipt) S E 5 W, SEC TIo,U •7d' T y.r/ /Q /5/W J'�,u o�,Py � � � <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING�GARAGE/ACCESSORY STRUCTURE—ADDITION- <br /> ch <br /> TRUCTURE ADDITION w = <br /> c <br /> c « <br /> o; R <br /> T ) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> n / c� y <br /> STRUCTURE/ADDITION USE: 4_1 Ll (ye(//A <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 511 <br /> 3 / <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> M w <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0 w <br /> m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m Fir <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 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- o <br /> INGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS l <br /> MUST BE SIGNED AND DATED BY THE OWNER. n c <br /> o � — <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a o <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P (i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 <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, v <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. <br /> ry �• m m <br /> 7. <br /> o : MZ : <br /> .w• ` m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best 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 d C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize io m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- E p <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other (a <br /> CD <br /> authorized person two have access to the above described premises at any reasonable time for the purpose of inspection. <br /> i�Gtrt.I // f° E <br /> SIGN HERE 7 – ,3""– 7 7 '^ <br /> Igna re of owner //Iding contractor) (date) f` <br /> ZONING ADMINISTRATOR <br /> V/hH 4*H4A <br /> NN C" N N(n <br /> IJP f" O pl P O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />