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071 j <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0Z <br /> APPLICATION FOR LAND USE PERMITS it <br /> ` l w 0 <br /> OWNER �6jfnP5 R„C ke)IV ��nso✓1 TELEPHONE (6/a) 777-J3ys' n <br /> o <br /> ^ �`”- t ) <br /> HOME ADDRESS `7CY�1 y ��I / �I1"q I C �(Jl' /(f- a 06, 11! m 0 s5056 <br /> EMERGENCY/FIRE NUMBER IUO n ROAD NAME <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) 2 P 76 Nb_ 1UF ag -y 0 <br /> Cft0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION aGk <br /> ' <br /> o <br /> v <br /> a' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> m � <br /> STRUCTURE/ADDITION USE: DWeI 1 n!�, ' 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ONSiJ , I6-J49 O w (� <br /> DIRECTIONS FOR PLOT PLAN DRAWING7 (AERIAL OR TOP VIEW) v� 0 p <br /> A PL <br /> '—i o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. J <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). c n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO Mca 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> � \ <br /> INGS, ROADS, LAKE, LOT LINES. w <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. M c <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° <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 /> -0d d O 0 -0 <br /> 6. � ' d6 a <br /> •o Cwwo� � <br /> 7. <br /> o fi� <br /> _v,: € I m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m ? C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m w E m <br /> that this information I am providing will be relied upon by the County of Bumett Wisconsin in determining whether to is- ': 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 m <br /> providing In this a Mication. I agree to permit county officials charged with administering county ordinances or other <br /> authorized perso o ave access to qQbPve described premises at any reasonable tftualaLlhe ur ose of inspec n <br /> SIGN HERE <br /> is pur of owner or ullding contractor) (date) I' <br /> ZONING ADMI STRATOR 3 0 <br /> i <br /> t)Hh40 4a L" <br /> N N°i Ncn <br /> °I f110Ncn(T 0 0 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRE 00 0 0 0 0 0 <br /> S07W- /0­�C-Ej-7 _ - <br />