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51 (�Nr <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -u o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> a o <br /> c <br /> Dtt-N ►32E55t-L b!Z-y55- by9y V <br /> OWNER TELEPHONE <br /> HOME ADDRESS 765cl 6pomi 1 Why -r0UVe1 (-"V15 tFg11-ft5 A)() 5"5-0-7.6 � <br /> r � <br /> EMERGENCY/FIRE NUMBER ROAD NAME 11th len USI ve o <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) j or I MAoLm AgE5, -r Lp 0 R 16 W,,Ta wo OF 5_W1 SS m <br /> � d <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION C —� <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> d ( <br /> m <br /> 0 r / <br /> STRUCTURE/ADDITION USE: ^v <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) M� <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. <br /> DIRECTIONS FOR PLOT PLAN DRAWING? (AERIAL OR TOP VIEW) O <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m +o <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 <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- (� <br /> INGS,ROADS,LAKE, LOT LINES. Q ' <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. m c <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a �M1 <br /> ISSUED. c{ v l <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 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 <br /> EOOHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. ��� ��^:^'�'/� <br /> M ' nr, GINO 'D <br /> �. m m q <br /> 6. � 3 n 0 fig <br /> � n m <br /> E Q w o w m <br /> 7. QQ <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Cr C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m : m <br /> that this information I am providing will be railed upon by the County of Burnett Wisconsin in determining whether to Is- m O <br /> Is- <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 this application. I ag to permit co ty officials charged with admi r -county ordinances or other <br /> authorized person t ave access o he above desAped d premises at any reasonab4 Iii s r 4 p $e of Inspection. rCD <br /> ': E <br /> H : <br /> SIGN HERE <br /> /slgni)t1rs of owner Iding contractor) <br /> ZONING ADMINISTRATOR . . . . . <br /> www fww <br /> N N U N Al <br /> V1 V•O V1 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED - - - -=,t o0 0 0 o S <br /> 000 00 <br /> (UX- Semi (�>-3--cj7 <br />