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P145A S Ce�YI�� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Ji3 m Dienstl dor v Z <br /> APPLICATION FOR LAND U: W9070ChipmunkLn. $ o <br /> Spooner,WI 54801 <br /> a ccs umlmjt e N w <br /> N <br /> OWNER d faa 4A 6✓eI Lc-c- TELEPHONE c <br /> m <br /> HOME ADDRESS cU 0 .LAlAd-gagAl L k E T;- M L _ (gam O <br /> N �o <br /> EMERGENCY/FIRE NUMBER ROAD NAME , <br /> LEGAL DESCRIPTION(see tax receipt) j 0'7-- O ��Cd 4 e� Q� y <br /> '� ✓IL - .� <br /> 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION C <br /> cr <br /> OL <br /> .S. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION R m <br /> STRUCTURE/ADDITION USE: '00'/' '3 M E <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR (J 1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In _ <br /> DIRECTIONS FOR PLOT P ANDRAWING- (AERIAL OR TOP VIEW) a <br /> 0 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. I ! o <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 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5� <br /> ISSUED. <br /> o- <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z (ZJ <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT N \ <br /> ISSUANCE. Q <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 /> 91 <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. A�1s �,y,** eAN&,,� be S.)14 1 <br /> 6. 3? tpo m <br /> a 9F n ?a <br /> = <br /> 7. q gc� we <br /> >a <br /> Zi r <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Cn. O <br /> ff <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 2 ; C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m'm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsi ' determining whether to is- ([}7� ' m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett g on ` 01 <br /> providing in this application. I agree to ' m '• ' <br /> g permit county officials charged with administeri g outKy.ortlinances or ol�r o <br /> authorized person to have access to the above described premises at any reasonable time F(�4 the pUtpbre of inspection.' <br /> n E i <br /> SIGN HERE E E <br /> ign re of ownery building contractor) 1 ii <br /> I (date) <br /> ZONING ADMINISTRATOR <br /> ._..... -. <br /> 400 <br /> NNNNNO N fJ 1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />