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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 1Z <br /> APPLICATION FOR LAND USE PERMITS 01 0 <br /> * r <br /> OWNER o O <br /> �U GENE F ET/j�/r <br /> 164 02� x/ TELEPHONE(d,z 1 7 7p 9s8/ m � � Q <br /> HOME ADDRESS g73(a A64VIer /4✓e /lJD ©n 9 / �Qv SSS Z� 0 <br /> EMERGENCY/FIRE NUMBER a 77 ! ROAD NAME (j7(�/ 7-k '%A I <br /> AD--40 x1 i 4w G yr L-Or 3 0)( C9M V 4 P ; /i &'X eS oW v $ 1 <br /> LEGAL DESCRIPTION(see tax receipt) /-4 P 97 4- d 1-30 Of 49 FoeCShi j//.? 0&2L&£!i!o <br /> m <br /> n <br /> 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING AGE/ACCESSORY STRUCTU RADDITION C <br /> Cr <br /> a <br /> 5.M <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> q� y <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR v <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n - <br /> DIRECTIONS FOR PLOT PL6N DRAWING.ING. (AERIAL OR TOP VIEW) 0 c <br /> A & <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE of a <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- G <br /> INGS,ROADS, LAKE, LOT LINES. SCJ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C�o <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. g c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT a 0 <br /> ISSUED. CAN BE O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z Q <br /> CONDITIONS OF PERMIT: o <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 /> 5. STbra��e i3ke T 6c ;:7� Jo'w uo,Ro w <br /> 6. � � md v L <br /> It 3 <br /> 7. of !A mi <br /> _CA ^0 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C : ? JMD <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i m E C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize w m m <br /> that this Information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- i p <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> - <br /> SIGN HERE N <br /> ign re ow llding contractor) (date) i <br /> ZONING ADMINISTRATOR l <br /> Nip Nom+ <br /> TOWNSHIP PERMITS MAY BE REQUIRED ' 0 0 0 0 0 <br />