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ni- c n-1-4 ' <br /> Burnett Coanty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U 0 0 <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> r <br /> a o <br /> p� w le L <br /> // 4 <br /> OWNER �a� 1JC�G� ogAj TELEPHONE �Z) - 7�(� y a <br /> m <br /> pp �/ n mow. Ll <br /> HOME ADDRESS ��1 } I We,6/2 !C D 4-Q �7iPi9 R IC m�• �jyC <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME KIS ) ~ <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) C)28 OZ 'S00 co <br /> o <br /> p y <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUREaDDITION V Q <br /> n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: 'L[o✓ ez <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 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T =- <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y \ c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- r� <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. n o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. pp <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z �Q <br /> CONDITIONS OF PERMIT: P xJJ <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. \ I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. U) <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. 17--qd JF <br /> ;a -0 nm O L 0 <br /> nim <br /> 6. .� a 70 <br /> 9001 im, <br /> 7. Z '• <br /> o <br /> =ys i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 3 c ; C U <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of '• m <br /> all information contained in this application(including any accompanying s, further declare that I recognize m E E <br /> that this Information 1 am providing will be relied upon b the County of Bu n q m <br /> P 9 P Y tY ln�db vgf?ether to is- m O <br /> sue a permit. 1 further accept all liability which may be a result of the Cou n �Sctlon. <br /> nIamproviding in this application. I agree to permit county officials charged adrn rlh oi� otherauthorized person to ha a access to thea a describe pre ses at any onable time for the purpose of .m <br /> SIGN HERE <br /> (sl ature of owner or A ing contractor) URN��COUA'(date) <br /> ZONING ADMINISTRATOR I t C I ' 1 'vTM . . . . . y <br /> hHHh� <br /> N N iT N N <br /> V1 O V1 N <br /> TOWNSHIP PERMI S MAY BE REQUIRED <br /> 00000 <br />