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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 64872 Office of Zoning Administrator M o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> F 0 o <br /> L / I R �7 /�J <br /> OWNER KQ-tk -I t �S V 1 \(l /1 TELEPHONE 7/S 3� 7- 8 7U(J a <br /> it 0 <br /> HOME ADDRESS 3 _3q6 6 /S O+/ FaoA I c- , Y// -Pyg 3 -) - ,Y,1-17 v o <br /> l)un La k �czzcQ <br /> EMERGENCY/FIRE NUMBER ROAD NAME 1 <br /> V ';k44p 33 7 s'4f�l l/6 f <br /> LEGAL DESCRIPTION(see tax receipt) co <br /> R (7 )V df e--5 2.f PCL- GQ v /ot/htl R. <br /> W <br /> TYPE OF PERMIT(S):DWELLING/BUILDING--X—GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> CA <br /> J� <br /> STRUCTURE/ADDITION USE: 1, kK A_ ff 0) <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) M <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 a _R <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) n <br /> -n oz <br /> m TD <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 � z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M c <br /> NORTH(N). to <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, I o <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS m. ` <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> 0. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr E <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c Q <br /> CONDITIONS OF PERMIT: n w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT XJ <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ry <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V <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. �Xlb+tr. ��cx�,ce/C— Q (✓I�� qe- Coo�Jwr W ;a -00 <br /> .A ( S�eK` r, Rpyog� v <br /> 11 '_ m <br /> 6. W F_a% �w -O`"�'� CoMp R c 2C w m 3 <br /> ZF MQ i <br /> 7. • <br /> o m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ii ': S C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ii E : s <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize Wm <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 amm ; 9 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other e <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection, m <br /> e : <br /> (D : <br /> SIGN HERE <br /> gn re of ow or uiiding contractor) (date) <br /> ZONING ADMINISTRATOR `q <br /> uwwwfnu.ui <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0 0 0 0 0 0 0 <br />