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0) an , <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator $ G o <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> N O <br /> s <br /> OWNER 1 C &J A N n O �- 7 \Z TELEPHONE Z —C1��-- �S—r/5' <br /> v <br /> �, /yJ?tL`CL�L7L L�QI b ��R�� ivSs <br /> HOME ADDRESS - - <br /> O <br /> ' r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) 02 L_ Cl 3,;13- 2 1) f y <br /> �>coo <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-.2L-,—GARAGE/ACCESSORY STRUCTURE ADDITION C ' <br /> n <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT o'SUBDIVISION � <br /> VJ <br /> � �� m <br /> STRUCTURE/ADDITION USE: �NOL) L.�}!CC !am11u✓r7� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 700 � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <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 <br /> NORTH(N). a 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M o <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 /> INGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 64 <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. m c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr )sC <br /> ISSUED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (� 1 <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 /> 6. �" (�T17iJl (o T , N ' 3n3F � <br /> m <br /> v t <br /> 7. Z !A0 <br /> _v,: i i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my g ? IS <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ' C B E A <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 ordinances or other CD <br /> 2 <br /> authorized person to have access to the above d premises at any reasonable time for the purpose of Inspection. T <br /> SIGN HERE <br /> (signature of <br /> owner or building tor) V (date) <br /> ZONING ADMINISTRATOR \e)rfYlIgolll w <br /> M �ninin«wM <br /> N K) En UU <br /> N t7lo O pptnp0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 000000; <br /> U L0V%._' Xfl 6-5-i? <br />