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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v OZ <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> \1 CD <br /> C <br /> OWNER ��\�) TELEPHONE .233 o a <br /> HOME ADDRESS 2`) S I� G a j`TpN \' I . Wim. �> Wil v 0 <br /> EMERGENCY/FIRE NUMBER <br /> ROAD NAME(:;,R3 <br /> LEGAL DESCRIPTION (see tax receipt) t\,ft 38 N ' S t13 Q <br /> 1 <br /> N ° <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> Q <br /> a <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> f) � 0 1 a -I- t <br /> 0 <br /> STRUCTURE/ADDITION USE: d �C.�'Cj"i C-I"C{�( C'1 3I . e- 7QC/O '- <br /> m <br /> (Home/Cabin; Commercial Business; Bedro ; Deck;etc.) � <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> N M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m ✓� <br /> n n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m fD <br /> NORTH(N). y o <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, " 1 Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 1 <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEM. <br /> ISSUED. <br /> O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: 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. ( rO ',( <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. ,{ fti <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, `U V <br /> PONDS, RIVECRJ`UNLESS SPECIFICALLY PERMITTED. <br /> 5. �C1 r�� /Cf/G krn'*Lo�( N �(p� L�� 11�i1�/0 rC�Q� � v 0 °D a DQ O V <br /> s. /] rr �P�G� /C,� / C k L� j �` " l�.l S�ru ltel/ m v N y m <br /> 1 ° 3nmxQ = <br /> a m c N , 0, s 3 <br /> z ym ° i <br /> 7. o 1` <br /> = � m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my runt Lj C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofr n <br /> Q' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- t7 <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 iu <br /> providing in this application. I agree to permit county officials charged with administering county ordinancesor other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> �t (D <br /> SIGN HERE 1 4�0 " S - 90 <br /> (s' contractor) (date) <br /> Al <br /> ZONING ADMINISTRATOR l� w <br /> f» cncn vi fn <br /> N Ute N N N Ut <br /> TOWNSHIP PERMI MAY BE REQUIRED 0 0000 <br />