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On Ctyinp- <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - a o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> C <br /> OWNER40 ci Q �/��/¢ H J �/✓ TELEPHONE <br /> HOME ADDRESS dV L Ad yP� �Y��� o <br /> 1 <br /> r <br /> EMERGENCY/FIRE NUMBER 2,o Nl A/e- DIST ROAD NAME <br /> Goer �o>✓ Sic 3S= 1�y Al 6 <br /> LEGAL DESCRIPTION(see tax receipt) fi F �G�AIQ f I N.^.N C _. 9 <br /> 0 <br /> N � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE—ADDITION— <br /> Q. <br /> S. <br /> N <br /> SANITARY PRIVY._—FILLING/GRADING CAMPING UNIT—SUBDIVISION 0 U <br /> ca fvRl <br /> STRUCTURE/ADDITION USE:n a hn A A-14 ✓ /Y*3 IVA —416-7- <br /> K � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ' <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR .n 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 H <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) -n a <br /> I l7 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. mit <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING($)TO ALL LOT LINES, (B)BUILDING(S)TO m p <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> 0 <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 W <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P O <br /> 0 <br /> CONDITIONS OF PERMIT: i <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. 3 HUI rn <br /> 6. v' 9Cwfeo93 <br /> N N O : O O <br /> o i �� i M <br /> 7. __rnf m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Qj GS c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize e : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. 1 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 administering county ordinancesor"othe} i CD <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of lnspectl -n <br /> m : <br /> SIGN HERE c' 1 <br /> re of o or building contractor) <br /> I ,'..,�� <br /> 40 <br /> ZONING ADMINISTRATOR <br /> iR V1 MiR HSN-+ <br /> 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRE 0 0 0 0 0 0 0 <br />