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06i7n "/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator T 4 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> Q <br /> � J <br /> OWNER <br /> O <br /> HOME ADDRESSG� <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER 0,4N{4-? LA_j (` RO NAME <br /> LEGAL DESCRIPTION(see tax receipt) L oT ' o Vvi V ` P Z 9/= <br /> y � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION_ n <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> N <br /> zof )4 z A� l,hl «� as ya ' <br /> STRUCTURE/ADDITION USE: .4 -i <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR �� .0 Cb <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n CL <br /> T ^ Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tan S <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C • 0 <br /> NORTH(N). y 9 <br /> 3 SHOW CEN ERL NE OIFOROAD(CE BUNSNS IN FET ILDING(S)NG(S)MEASUREMENTF THE FOLLOWING: (A) UTO HE(ORDINARY HIGH WATER MARK I(OHWM)OF LAKE, m v <br /> Z <br /> 0 <br /> STREAM OR RIVER. <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 c <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P I <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 <br /> ,'I,PERMITTED. -f <br /> 5. rnAX N --um& OF &J0^j -c b2 TWO— ;asmr.�ppj ° ° m <br /> 6. .. azw �cl. .'0 <br /> C on 05 <br /> Z : <br /> 7. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zf g C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize9 : m Z5 's rn <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 <br /> providing in this application. I agree to permit county officials charged with admi r <br /> E f <br /> authorized person t e ess to the above d d premises at y reasonab ori ' eb I m <br /> 0 <br /> A <br /> SIGN HERE <br /> I ture of ow building n ctor) �11 <br /> ZONING ADMINISTRATOR N w N N <br /> N N u•, . <br /> TOWNSHIP PERMITS MAY BE REQUIR — <br /> lc� Mc <br />