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On CD)I�P, <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 o° o <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> r <br /> N O <br /> c <br /> B <br /> OWNER �� r• 6; 1,-.,9V <br /> TELEPHONE �•71 -Z) <br /> O <br /> — m <br /> HOME ADDRESS 9 S— h r-h L f3 A/W 0 <br /> V'or, o <br /> EMERGENCY/FIRE NUMBER ROAD NAME 17/ 11f14 6? X f7 <br /> LEGAL DESCRIPTION(see tax receipt) fel , LOT-3 ' 55q�-, C*( a <br /> E. <br /> c <br /> 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> cr <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 `J ✓ <br /> C <br /> STRUCTURE/ADDITION USE: rd 13%h Bea 1? 5,- <br /> (Home/Cabin; <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 'a 41-1 <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 /> ju m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T 2 <br /> T <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). W c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO fit 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. w <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 6 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q 0 <br /> ISSUED. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <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 /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> q y <br /> 5. f ►GI(itr "� pt;rt` U Q�crtG{ ©%O 4)'F- ea� /rl4^Fa Lir /u�, - 9 <br /> � tur � tC . vti Ir�Gf!MJ � � .0 vm`a mm� <br /> oo 0 -0 <br /> oL <br /> KSall <br /> T6. /0,0,,.644Ao <br /> /pacNN �r <br /> N007. ZO • t1o <br /> : <br /> y: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ? 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- m O <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 f m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m . <br /> SIGN HERE <br /> Is na re of owner r bulldin contractor) <br /> r Y <br /> ZONING ADMINISTRATORC�— / w <br /> u�wwwuw� <br /> N NN 0 P P N Nfrl <br /> O P0 <br /> TOWNSHIP PERMITS MAY BE REQUIRE <br />