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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator v Oz <br /> APPLICATION FOR LAND USE PERMITS 3. 4 <br /> w 0 <br /> w <br /> OWNER ryle `j'I�Ilys� TLJry�IS•6�✓ TELEPHONE 4 1/3d 6yd.c- v a <br /> Ir O <br /> HOME ADDRESS /38/.(- Got(L.D A/i- APPLE VAI LLky, 1? inlA/, rs"iAy <br /> o � <br /> EMERGENCY/FIRE NUMBER ROAD NAME derv,*LCR r-e <br /> LEGAL DESCRIPTION(see tax receipt) LO*r/R loo2j- Q -'6CV-j% LoST �C ay+�vw Rorzl W I <br /> e77- <br /> vv � y o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-� A <br /> GARAGE/ACCESSORY STRUCTURE� DDITION <br /> ADDITION- <br /> Cr <br /> n <br /> 5. <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> N <br /> of <br /> STRUCTURE/ADDITION USE: HOM Lc G A!2 RGA <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 r I <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 rA <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). W 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD;(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, z <br /> STREAM OR RIVER. c <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. `z <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I <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 o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE w ° <br /> ISSUED. -� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c (� <br /> CONDITIONS OF PERMIT: rvfil <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 WITJ�IN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMIUED. g__ <br /> 5. /'f SfDti (N4•,/�r�6� eG�.�[v.w � ' pL�//f11� X -0m r O o -0 <br /> 6. N-Ott e (J 4i t fn 4u�+ a c�rd, 1. w `�- #%ACOgL t,�r�less S fl a W�/ a Q <br /> n > n 3 <br /> 7. /' 'Eti o i � �o : m <br /> 6~ N �� .� <br /> =y: : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm ` C <br /> CL <br /> all information contained in this application(including any accompanying schedule)and 1 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- i i v <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 0, <br /> providing in this application. I agree to permit county officials charged with administering rdinances or other ; 0 E <br /> authorized person to have access to the above described premises at any reasonable time fo _Pur ose o <br /> Fn <br /> SIGN HERE " 3 E <br /> (sig ature of owns or Ilding contractor) 4 SIR <br /> ZONING ADMINISTRATOR t Y1A„ <br /> aa�� G�� Se�� Go'A ADMINISTRATOR <br /> L o 'NO <br /> 71 (N71NO <br /> O �r f TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br /> 000 00 <br />