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6y) G&W) <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITS X ir o <br /> w <br /> i <br /> OWNER � � m e $ ,f 4� S TELEPHONE g 6 � 7S <br /> O <br /> HOME ADDRESS N 11� <br /> 43 7L 4 h ,I <br /> EMERGENCY/FIRE NUMBER 7j g� ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt)S.94/r/ K /h � 5 E �s/nd �iLF�he I y <br /> Ff ��I��/S� � o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE DDITION a <br /> 5. <br /> Lo. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: 1 Le, �[�'� ' • �Y'a eJ �l�X.3� <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. w <br /> w <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Tj CL <br /> m <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn _ c <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m (I 1 v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> O <br /> STREAM OR RIVER. <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. <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. ° <br /> v � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q E I <br /> 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z PJ <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Y <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. t�X 'a0r- m <br /> M 3 as A <br /> 6. w w o ��° q <br /> Z : <br /> 7 0 : <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my G� ' C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o i ` C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 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- <br /> sue a permit. I furtherept all Iia which may be a result of the County of Burnett relying on this Information I am <br /> r a m <br /> providing in this app ion gree to permit county offici c with administering county ordinances or other <br /> authorized person h cress to the above described is t y reasonable time for the purpose of Inspection. <br /> m : <br /> h i <br /> SIGN HERE <br /> ( natu own r or bull nVactor) (date) i <br /> VIE <br /> ZONING ADMINISTRATOR <br /> QN MM• N0:W r <br /> O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 <br />