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a)l CL's <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator 3 <br /> APPLICATION FOR LAND USE PERMITS - <br /> w <br /> - w <br /> c <br /> OWNER ILvY fS�cU Oci�JIP�-�C1Q!'f TELEPHONE m <br /> � / a PO <br /> w� 41HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME ✓al�h �pQdl <br /> � / 1 r <br /> LEGAL DESCRIPTION(see tax receipt) /OLuh i0 S_� �� 2? do <br /> y o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSOR STRUCTURE ADDITION a <br /> w <br /> SANITARY PRIVY FILLING/GRADINGX —CAMPING UNIT SUBDIVISIONfir <br /> N <br /> STRUCTURE/ADDITION USE: / // 7 �ae % ����QQ� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. X c 11 <br /> DIRECTIONS D <br /> FOR PLOT PLAN RAWING• (AERIAL OR TOP VIEW) A Z <br /> o <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 — o <br /> NORTH(N). m <br /> rn <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO 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. N <br /> ED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANN ) <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. p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE g ° <br /> ISSUED. <br /> Z ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PERMIT: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH 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 /> PON S, RIVER UNLESS SPECIFICALLY PERMITT D. <br /> dlt o ��i ta•�� //y1/m�. 7° m to C m <br /> 3 a3Fnv = .� <br /> 6. w O N J m <br /> o : fe �) <br /> 7. =m m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my g ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? , x <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- m <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 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 /> SIGN HERE / (date) <br /> is re of owner or building contractor) <br /> 4W 4W 40 <br /> ZONING ADMINISTRATOR `j "ul <br /> h <br /> N N ul" N N <br /> Vt 01 P 0 P 01 P 01 0 0 <br /> 0000000 <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />