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caYL C " ' Y " <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v o 0 <br /> APPLICATION FOR LAND USE PERMITS . < <br /> r <br /> Nor t. <br /> c <br /> OWNERTELEPHONE <br /> =�n � v;��� G �e«✓.�1 wiz- �90 -a96 d '� <br /> ``�� ,/ <br /> HOME ADDRESS �.37'G:S �itlUri ryi L� R q. '13✓jLi,,j.) d f a , A14/ 5,5337 <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME .S/�o�a/ � � �/L <br /> LEGAL DESCRIPTIONti tax ax recec m <br /> ( p)#o? Sf�7�'eaGQcdn/ - I.br/Ct4�l�9e �-Tow2sh�p �hctso � <br /> ur <br /> o < <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> o. <br /> S. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> to <br /> m <br /> STRUCTURE/ADDITION USE: -r/ i A dj Z7Y-N 0ivi�i / 6 <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 3 <br /> 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> t. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m g ;b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m U� a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. P <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,S o <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z �( <br /> CONDITIONS OF PERMIT: P 1 <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 /> M ' 0r o �om <br /> 6. 5' C o ' 3 <br /> 7. Z . : :1� . .'0 <br /> o : <br /> =y : : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i ? 3 c ? ' i <br /> C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E '• <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C 'm m <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. 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 E m E E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> SIGN HERE <br /> (Stntze of ow r ding contractor) (date) <br /> ZONING ADMINISTRATOR fn <br /> HHUH��� <br /> N Ntn NN(T V7 <br /> (T N0Nto00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />