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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> r <br /> S3r C <br /> CL <br /> C �e <br /> OWNER vl/ / fi �JA x/ �f d/�1Dr TELEPHONE�1Z �Q�39g z <br /> HOME ADDRESS 36 g 5[fh,� 11,07 lf�p" ' A/a Ofl KDAG E;1�1r[� SS�zB $ 9 <br /> m <br /> EMERGENCY/FIRE NUMBER > >'i ROAD NAME <br /> W S v.CLV 2�� 1 S r'°a�Q 1\We161 <br /> MEO%P w 0 ORS J — <br /> LEGAL DESCRIPTION(see tax receipt) i W�1�'��i� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION `v <br /> n <br /> 5. <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION— <br /> ca <br /> �� �� <br /> STRUCTURE/ADDITION USE: l q 1g bNo I a <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 < <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> _n — Z <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 C n <br /> NORTH(N). y 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, Z <br /> STREAM OR RIVER. ) <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 S r <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,o 0 1j tF— <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. 2 <br /> ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c Q <br /> CONDITIONS OF PERMIT: p , 1 <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. <br /> x - o ar, v?o -0 <br /> �' ' a <br /> m <br /> 6. '� � CHa' o53 <br /> 7. Z : F 0q <br /> =y m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my tic 10 <br /> C <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> Fri <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d 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 adminis U9 county ordinances or other m ': <br /> authorized person to have access to the above described premises at any reasonable t o Inspection. -n <br /> SIGN HERE <br /> (s stuff of owner or g contractor) j (date) <br /> (!' ,i EP <br /> ZONING ADMINISTRATOR <br /> _ <br /> TOWNSHIP PERMITS MAY BE REQUIRE �— ``" 00000 0 <br /> _ 00000 <br />