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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -U0 o <br /> APPLICATION FOR LAND USE PERMITS <br /> N 0 <br /> OWNER A _ �� 9�YfF�r�' TELEPHONE;F,o I_,rgVZV O \' <br /> HOME ADDRESS <br /> o m <br /> EMERGENCY/FIRE NUMBER 277 ROAD NAME be <br /> is �9 abs 38y Rrv�/yio c <br /> LEGAL DESCRIPTION(see tax receipt) 'S141 �T_-38 _ �_�`'O Gres 3 s (a <br /> c'f, Ipc <br /> y � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE�ADDITION a <br /> 5. <br /> SA. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> N <br /> d <br /> STRUCTURE/ADDITION USE: L�'' b� �' Sir <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) gv <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. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0c <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 Mc <br /> NORTH(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(OHWM)OF LAKE, Z <br /> 0 <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS -i <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ° <br /> ISSUED. <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 <br /> I <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. z - mm o?oM <br /> a <br /> M <br /> n�^ woS <br /> 6. v ? wa0 : <br /> Z : 5,2 <br /> 7. o <br /> _v,E E E m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i �G,S E ID <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o of <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize o '• m <br /> that this Information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d `: <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 E 9) <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> o : <br /> .01 <br /> /3/y �- <br /> SIGN HERE <br /> (signature olpfner or building contractor) (date)- <br /> ZONING ADMINISTRATOR Im �a111 iR N N N H M N <br /> N (N7�Ot,N7i tl00 <br /> O0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />