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Burnettfi:ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator T o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> r R <br /> Soo— �`{i_ 0 vw\J <br /> [�A n <br /> OWNER D6NN "1��j�'"� TELEPHONE <br /> HOME ADDRESS 'Z �E-V�(r S -C�t— ��i (,. 6_&.5TFCZ �O 9 V) <br /> n (� <br /> EMERGENCY/FIRE NUMBER a-7-7 ROAD NAME 5 u< <br /> I_.oT 11f 6F 5-6G'<-0NE cotTE2'5L5ut3Dtvk5to OF Cp0V=4rWMIEN?' LOT Z rN J <br /> LEGAL DESCRIPTION(see tax receipt) y�2N �3 T GO `��P Lio JVoRT'h t R 4-,eu64L t 6 ,v Es <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—)L—GARAGE/ACCESSORY STRUCTURE—ADDITION— <br /> SANITARY— <br /> TRUCTURE ADDITIONSANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: �FOMf':� /C-Aeo3 6t <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) -o <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR .n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. A m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M n <br /> ANORTH(N). def y ° <br /> OW FEET OF THE FO G: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <br /> NTERLINE OF ROAD,(C)BUILDI (S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, I Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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. Q <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. �O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE `" ° <br /> i Cr M <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o O <br /> CONDITIONS OF PERMIT: <br /> ^� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. t <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. p <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, �LI <br /> 5'. lTnn/^P..}-ONl/ID6S, RIV�ER UNLESS <br /> SPECIFICALLYEjRMIITTEtD-•c. ./1!u�/ ' may•./ L /y, 1 75��J'fL� /5/O¢fh,r/!.( <br /> 11 <br /> FaikJ <br /> Vtn"'4geS yC.'4�t 1 5, ee . 9;av n g o k 0 m <br /> oL <br /> OLld <br /> 'CD <br /> C 01 0 o6 <br /> 3_ <br /> Z �^ m ° <br /> 7. <br /> = rn : 1 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 o. C <br /> all information contained in this application(including any accompanying sc u decta th;lt . cognize (^ � : m <br /> that this information I am providing will be relied upon by the County of Burn si � her to is : i R t7 <br /> sue a permit. I further accept all liability which may be a result of the Coun R t I it n I am � ? m E <br /> providing in this application. 1 agree to permit county officials charged wit�i ministering coun ordi o other E CD <br /> to E <br /> authorized person to have access to the abovq described premises at any reas able tirqq, r the purpose of in ction. <br /> CD : <br /> IJUN 74 1"902 <br /> CD : <br /> SIGN HERE <br /> (si ature of owner or u l g contractor) 91 RETT Ol <br /> ZONING ADMINISTRATOR ZO NGXA <br /> fn fn to fn cn v+�' <br /> N N (TNNfn Ut <br /> O 0 0 0 00 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />