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(5� C <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator p o° o <br /> APPLICATION FOR LAND USE PERMITS <br /> N H `J <br /> + r C � <br /> OWNER <br /> C. I�1f i S �2 V TELEPHONE - lel Z Q�8-�� � lT' <br /> HOME ADDRESS44/7 /(��2<� / U L� /C�J/ Y /�]/ X/I/<Li S <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> I r S <br /> LEGAL DESCRIPTION(see tax receipt) ,, 34 Tcawns�►i In PSIJ S k/ m —3 <br /> T c n` <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUREADDITION n <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> N <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <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. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c <br /> n ii <br /> �1 O 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 O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 00Z <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. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 64 E <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 ° <br /> 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q ° <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT l <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. �j�Sijg ///3j9� .SPJC-- ,n�f z -0 0 m v e o -0 <br /> 6. /?1S/srJ Co l r0//��Qf tlre'� i� / 6�LC� C o . �T. <br /> R N O 23 <br /> 7. <br /> O <br /> =m: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my a5 c : p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a E c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize e e : 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 further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other e <br /> authorized person to have access to the above described premises at any reasonable tIpjAjqr the purpose of inspection. -n <br /> r�) __ _, , <br /> m <br /> CD <br /> 40 <br /> SIGN HERE 6 <br /> (sign atur eror ildl actor) , (date) <br /> ZONING ADMINISTRATOR ` H fn h w fn w <br /> LL <br /> N NO� NNO�N <br /> V7 N O of O�0 0 <br /> I O 0 6 6 0 0 0 <br /> OWNSHIP PERMITS MAY BE REQUIRE - c O o O o O O <br /> I___— <br />