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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator T o° c <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER 'PAJ2)( TELEPHONE <br /> /� <br /> S P <br /> HOME ADDRESS L4341 4 L[)P1C4 A✓e SO. MEnb 111,E '42!z <br /> EMERGENCY/FIRE NUMBER c�. ROAD NAME 6,.e,,'1 J Q4 l�� O .. ZV <br /> LEGAL DESCRIPTION(see tax receipt)-s.� � Z-0�/�/7 ryW� CO <br /> TYPE OF PERMIT(S):DWELLINGIBUILDING_ �-- GARAGE/ACCESSORY STRUCTURE ADDITION Cr <br /> 5: <br /> S4. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: l Y �E ALL LO Fd fb <br /> (Home/Cabin;Commercial Business;Bedroom;Dock;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 3 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE off <br /> n <br /> NORTH(N). C <br /> w <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m p <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 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- C <br /> INGS,ROADS,LAKE, LOT LINES. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Lv <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS �. c <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE g ° <br /> ISSUED. 2 <br /> THIS PERMIT 15 SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: _ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY V41DTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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. n o O <br /> Ii taI; <br /> 6. $' 0 g s� <br /> zt eg fO1 <br /> : <br /> 7. o ` w's m <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my ? G1 g <br /> knowledge and belief it is true,correct and complete. I acknowl a detail and accuracy of o <br /> �doc rmini g at I whether to Is- n m <br /> all information contained In this application(including any a <br /> Is- <br /> that this information I am providing will be relied upon by f n rmining whether to Is- ? i <br /> sue a permit. I further accept all liability which may be a s u re i n this information 1 am s,' <br /> providing In this application. I agree to permit county oHl charged with adminlatering unty ordinances or other E m <br /> authorized pens to have access to the abo a described p sea at R40 of r purpose of inspection. T <br /> i <br /> V7G -�rl « ` ` <br /> SIGN HEREUNI� \ <br /> (signature of owner or*lid Ing conlrac ZZONING�{C7 (dam) <br /> ZONING ADMINISTRATOR « «« <br /> ~ <br /> « « 0, <br /> N N N N N N <br /> N V•O p1 fT 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 8 8 8 8 8 0 <br />