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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> it 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> G Q <br /> OWNER }Z U G�1 Yv S tti TELEPHONE E. <br /> C) yz <br /> S �9 ' ( / <br /> HOMEADDRESS_--3D__ qN. 3 +J- hY1 b.164. 1/y ` fs3z) r <br /> EMERGENCY/FIRE NUMBER E L3 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) �/ Cn <br /> x 1 y 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION- <br /> SANITARY- <br /> DDITION SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> ti O <br /> STRUCTURE/ADDITION USE: Ir S <br /> (Home/Cabin;Comm ial Business; Bedroom; Deck;etc.) T <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 7O0 a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). CA 3 <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, o <br /> STREAM OR RIVER. h)CJ <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 1 <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 PLANS5. <br /> MUST BE SIGNED AND DATED BY THE OWNER. o V <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c (� <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. IIJJ <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. <br /> A)4e. � de1 (o� 1�� z = gym <br /> / r1 // p E a <br /> 6. TIS LJwe Ui� f 6 ' G�(R�� CCcVkD �1CLeecf X1`6 ' cus'i <br /> 7. � Q �� ' Z : N N <br /> I declare that this application (including/zany aWccoom yang schedule) has been examined by me and to the best of my V ; c p <br /> O€ c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? n <br /> all information contained in this application(Including any accompanying schedule)and I further de_c gnize m m <br /> that this information I am providing will be relied upon by the County of Bur issue a permit. I further accept all liability which may be a result of the Coun r t iTto <br /> Iam02 <br /> providing in this application. I agree to permit county officials chargedwi t o finanother authorized person to have access to the above described premises at any rea able time for the purpose oftion. m <br /> ' 4 : <br /> SIGN HERE <br /> (sl at roof owner r b it ng contractor) 13UFINETT C09 <br /> ZONING ADMINISTRATOR �` <br /> Cn <br /> wwC"CA <br /> N N V1 NNU1(T <br /> V7 (T O V7 V7 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> U607IT -"��` <br />