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on <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 64872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> . a <br /> c <br /> OWNER ?1 ,4 11G -f ZI t 04 g/ji✓dpw/ TELEPHONE 7/S'(y 3 S— 6 997 <br /> �J <br /> HOMEADDRESS f2,1 7 15L -O%S' Z)/C/!�1 &1993Tge' , (�c1 L 5,449,3 r 1 <br /> EMERGENCY/FIRE NUMBER a Q Z/ ROAD NAME ELL%S 4,41"VAC., 1 .. <br /> LEGAL DESCRIPTION(see tax receipt)O4,7r-Lar-� .r�e,'J� � rj� R/! �-I-VWN OFf007T 0 <br /> Q <br /> y � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT S^UBDIVISI1ONn,,,�}r3 <br /> STRUCTURE/ADDITION USE: �rr>: C 7-0 1449— `� /"Cte L /caL/0,P*j� 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) ' <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. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> M o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE In o <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 _jPa <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. y <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. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. I) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <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 PERMITTED. <br /> 5. fmr w d� I J Com- % T-�' ;a - m m 0 0 -0 <br /> M <br /> 2O � 3 n Q= m <br /> 6. ai 9Now3� m <br /> 7. 0 <br /> _ <br /> 's m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS i A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I 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 recognize m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 administering county ordinances or other m <br /> authorized perso have access he above described premises at any reasonable time for the purpose of inspection. T <br /> w : <br /> SIGN HERE <br /> gna re of owner o building contractor) (date) <br /> ZONING ADMINISTRATOR w w w <br /> N N N N lr cn <br /> fr f710 N 11100 <br /> 0C3o <br /> 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 o <br /> 00 0 0 0 00 <br />