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' c <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator a I-) Y z <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> a <br /> r <br /> • <br /> /y—J <br /> OWNER �/.L / [Y 7 TELEPHON7�rj <br /> HOME ADDRESS 6e0 R- �J Z;t�L T!X <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER 7 3 ROAD NAME a <br /> .1 <br /> LEGAL DESCRIPTION(see tax receipt) p V �•7 G SNI V 4 T f Avl-? CEJ, AZE EAS, <br /> Q <br /> ca o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION e <br /> Q <br /> CL <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: U / l L f 'y l/ ��Ly c �� n 7f ' w /5 I C)yesaC <br /> (Home/Cabin;60mmercial Business; Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR a <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T �2 Z <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S <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(OH WM)OF LAKE, pQ� <br /> STREAM OR RIVER. N 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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS r <br /> MUST BE SIGNED AND DATED BY THE OWNER. ro c <br /> _v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a <br /> ISSUED. <br /> r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 7_ Q <br /> ISSUANCE. t/]� <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. QQ <br /> A � m6. ' 3F� M <br /> a m <br /> .. <br /> 7. Zi PMQ �m1 <br /> P : <br /> =Coi i m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my Qy c IS <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am res ° <br /> g p g responsible for the detail and accuracy of OQ� ? ii� <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize (11 W m .. m <br /> that this information I am providing will be relied upon by the County of Burrett Wisconsin In determining whether to is- `I:: m :: v <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 application. I agree to permit county officials charged with administering county ordinances or other (D <br /> authorized p6m4n to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> co : <br /> H : <br /> SIGN HERE ' 3 �'�'r�Z7 <br /> i n re of owner Ilding contractor) (date) f�, <br /> ZONING ADMINISTRATOR <br /> N N N 01 N <br /> U N PRP, <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />