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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator a G / o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> w 0 <br /> OWNER le ICNR2 P A # ?SAN tr' SRI 7TC4 TELEPHONE(1012—) -777 -439t I <br /> HOME ADDRESSFII f,� /4►2 Ml1I SII O Ir <br /> \ O <br /> 23!00 G��H A/1 c r4NE <br /> t _ � <br /> EMERGENCY/FIRE NUMBER ROAD NAME1 <br /> So• <br /> LEGAL DESCRIPTION(see tax receipt) , <br /> 6.v r jor <br /> XEC77ojJZ4 ft P 'Sim6koidir I 6jar ca <br /> TYPE OF PERMIT(S):DWELLING/BUILDING y o <br /> GARAGE/ACCESSORY STRUCTURE ADDITION <br /> CL <br /> S. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0' n` <br /> �.J <br /> STRUCTURE/ADDITION USE: � u7 �� u� ( I <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) W <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PI OT PLAN D AWING• (AERIAL OR TOP VIEW) <br /> n 1 <br /> I. 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 C 6 , n <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO fyrl } 9 <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- o <br /> INGS, ROADS, LAKE, LOT LINES. (J) <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. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. o, <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. w <br /> CONDITIONS OF PERMIT: Z I <br /> P <br /> 7. 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 /> 5. PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. � n. � "t <br /> g <br /> 7. D i 9t C w w o <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to theM <br /> best of my g <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of : m o C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m� i m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- �, i3 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> providing In this application. I agree to permit county officials charged with admin( er <br /> m <br /> authorized person to have access to the above described premises at any reasonable ifn for the purpose of Inspdctixun. ' m <br /> CD <br /> SIGN HERE ���, ' ! m <br /> si aW reof r or building contractor) <br /> ZONING ADMINISTRATOR I <br /> Ha+NHfn to N+ <br /> Nutty <br /> N U O ul <br /> TOWNSHIP PERMITS MAYBE REQUIRED0000000 <br /> P O O <br /> 0 0 0 0 0 0 0 <br /> Ur�C' 0000000 <br />