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0" Co I <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator 0 o° a <br /> APPLICATION FOR LAND USE PERMITS a. 4 <br /> c. 0 <br /> N .o <br /> c <br /> OWNER /��1v SsA,/ TELEPHONE Z1 6 <br /> �'eQ'�� L, a2S�/ — 3 l o <br /> d <br /> S <br /> HOME ADDRESS yy 6 O <br /> .�Lt) � � ��O %Tf�'r7 .�hwN .712 �DJN/.3ec/Zy 1.112 �i' '��'� C. <br /> o �^ <br /> EMERGENCY/FIRE NUMBER X877 3 ROAD NAME 1O77-f 9Aw u 1 <br /> ( <br /> SU <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) U i / ( ,�C <br /> uJ <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE DDITION cr <br /> CL <br /> 5. <br /> S <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> m <br /> STRUCTURE/ADDITION USE: GA946f <br /> ay'f-a 4' <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> 700 C <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) p o <br /> n a <br /> r <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). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO lin 0M <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. N <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 /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE '" o <br /> ISSUED. g <br /> I <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 /> X -Vnr okov <br /> CD <br /> �. mm <br /> 6. ; <br /> � CYe p10 5' 3 <br /> 7. Z . <br /> oH 31� ,� q <br /> : <br /> ca' 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 ofCL <br /> m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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. 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 administering county ordinances or other a <br /> authorized person to h e access to the aoWe described premises at any reasonable time for the purpose of inspection. m <br /> - : <br /> m <br /> SIGN HERE <br /> (s-� M I gnn'atureoff owner or building contractor) (date) <br /> ZONING ADMINISTRATOR _ `JIofG7(l)q2Q <br /> hhHw40w� <br /> N N N N N I11 N <br /> N fTOtT tn00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />