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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 yzr <br /> APPLICATION FOR LAND USE PERMITS _. r\ <br /> w � <br /> c <br /> OWNER ,. ��r ' {r TELEPHONE 7 <br /> G�h Q c 'l v1 c 1 S 1 {% 5-- cm o A <br /> d <br /> HOME ADDRESS t 3 SJ Y SP�u;� ^ O <br /> ir / <br /> 0 <br /> EMERGENCY/FIRE NUMBER ( 3 5�u ROAD NAME L4y <br /> i I � <br /> LEGAL DESCRIPTION(see tax receipt) S r✓ ' /T 3 /2 (,J l .A Z .3S <br /> �/ � N <br /> o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING ARA /ACCESSORY STRUCTUREXADDITION U <br /> U <br /> CL <br /> 5. <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> r _ <br /> L� R (n <br /> STRUCTURE/ADDITION USE: L ��f 1 0Cb <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y " c <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, Z <br /> STREAM OR RIVER. 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. N 1 <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 'o <br /> O 9 ry <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. Z <br /> CONDITIONS OF PERMIT: P 90 <br /> h I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I kJ <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 /> PO—NDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5' 1 P7 0 62 NO D�rNStcjQ LvA4,pv^ pr -55µk Syj� v/-% Or jyr,7�tr�on. <br /> lV IE?SS S-t-Aff- eq /n O A m yr O 9 <br /> 6. (.l r.PI/4 - prt,041 .SPwur S /S !NS✓<a � H' v RL <br /> c o ' 3 <br /> 7. cc'YY�� Z : w M Q <br /> o : <br /> : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ti c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofa 9 . <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize w o m <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. -n <br /> CD : <br /> (D : <br /> v' <br /> SIGN HERE/'^7" 1--7 16 <br /> gna re of owner o lid g contractor) (date) <br /> ZONING ADMINISTRATOR wNU1 wNfJ1 fNOnwNN«NUt.O(nT fomUOn <br /> 00 00 0 0TOWNSHIP PERMITS MAY BE REQUIRED 0 1 <br />