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�% e l <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator $ o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> W o _ <br /> OWNER ljlq /l J C �/�L �jvl J Cf TELEPHONE �/ Z / 2Y J/ a <br /> o <br /> HOME ADDRESS <br /> // , c <br /> EMERGENCY/FIRE NUMBER ZZ/1 -J �C lLY2n cAOAD NAME ? rt 24,244-1.-r <br /> LEGAL DESCRIPTION(see tax receipt) <br /> ca <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION ccr <br /> / ^ <br /> 11 uJ <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> � y <br /> STRUCTURE/ADDITION USE: '�✓ — / Z�'3( It <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. �` l — la �C / 7 x N ` <br /> DIRECTIONS FOR PLOT PLAN DRAWING' AERIAL OR TOP VI rl 411 <br /> � <br /> CLz <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 'p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m IF <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 rn 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, r Z <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. 0 '`` <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q S W <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o C)� <br /> CONDITIONS OF PERMIT: ' 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <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. m 'Dmmv$v6. m <br /> � 3a'a coR' -ate.- .0 <br /> It 0 00 <br /> 7. c ' =3 <br /> Ch <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my p? t3 c ; ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o ` E <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 90 iv <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 applicatin 7 roe to permit county offi s charged with administering county ordinances or other m <br /> authorized person to h Ce s to We above described remises at any reasonable time for the purpo a of i spection. -n <br /> CD i <br /> � 1 <br /> 6 <br /> &UZZ26 IL <br /> SIGN HERE <br /> (sign rot owner or u contractor) (date) I t <br /> N E i E <br /> ZONING ADMINISTRATOR ��� " �` ` <br /> SHL"""hCn <br /> �r N fnn 0 Enn Ln 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED,, _ ------- <br /> O 0 0 0 0 0 0 <br />