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G J <br /> Burnett County 7410 Co. Rd.K, No.1102, Siren,WI 54872 Office of Zoning Administrator 0 ! o <br /> - <br /> APPLICATION FOR LAND USE PERMITS a `- �j <br /> UF <br /> TELEPHONE <br /> OWNER Tj�c'7T`n"AS COo K �-7I5 ' 3a? � �rJ(09 m � J' <br /> O <br /> HOME ADDRESS %0 to 0 �¢ y Q�NbS �Q�C fl o W zSG + S�-Ig3 N <br /> )sq* ° <br /> EMERGENCY/FIRE NUMBER q&3-531t t ROAD NAME V3FlI5S*&?,tN6 f:ZrJXf ( ~ <br /> —(�O,-T%-kkE ��o+]n�Z W36 1350 V SET o I- TIE Fi^3T' dJ� E f GF :H E �t/LT A6ks-r QVA'tTC e, � r <br /> LEGAL DESCRIPTION(see tax receiS �� SJ/V vy�oF Gt�VN Id-�7owNS7t�P 3-7 NaVTIA <br /> er esus /$ w ss 9 gr`i:��T Go. i W-Zseon+s�e,� ' a <br /> w <br /> o A <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION Cr <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0Ch <br /> � <br /> STRUCTURE DDITIO USE: Ql✓r RmTrN / lf�µ,f�. L-06 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) M <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING* (AERIAL OR TOP VIEW) r $ <br /> T 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 rc <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> Z <br /> STREAM OR RIVER. I1 c <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. i <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. ° <br /> O � I <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 <br /> CONDITIONS OF PERMIT: i <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. �) O <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. f` � <br /> 5. // ��� /ICV ©�a9yCetnee4__ r` e_ 1OA �ru41// O� <br /> SAFIF 4#C / / A M m 0 O O 9 <br /> �+ a I to <br /> 6. 9'� � cHo3 <br /> Z : mQ <br /> 7. o <br /> _Cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my E c E E E A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n E <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize 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 i <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> e : <br /> SIGN HERE <br /> (signature er builds Vactor) (date) <br /> ZONING ADMINISTRATOR w w w u w w <br /> NN°1 NN NN <br /> N 6n O N fJ� 0 0 <br /> OWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />