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On <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator111 0 <br /> APPLICATION FOR LAND USE PERMITS a 4 <br /> w <br /> OWNERCSTgT�- eog D TELEPHONE ��7{�J�_j�J p'2 -}-�y�L�7 <br /> HOME ADDRESS 6 S3�. .Smtwel /) RID ., ebaC_er' W_l <br /> EMERGENCY/FIRE NUMBER ROAD NAME S� TrT� yO <br /> LEGAL DESCRIPTION(see tax receipt) SGIf Z 5 a. 140 y k 1 4 VJ g � <br /> N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING---,—GARAGE/ACCESSORY STRUCTURE ADDITION <br /> o' <br /> SANITARY X PRIVY FILLING/GRADING L / CAMPING UNIT SUBDIVISION— A <br /> CA <br /> STRUCTURE/ADDITION USE: O.�tl' 9r�E RS g <br /> (Home/Cabin;Commercial Business; Bedroom; eck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 333 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. �p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m n <br /> NORTH(N). U) o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDINGS)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. `t p <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 S <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> D <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. 4 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: q <br /> 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I' <br /> ISSUANCE, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3 NOGRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 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 /> QM -00 sg0k0 .0 <br /> 6. J* 3, q�f-wao�. E <br /> v Cw <br /> 7. o � w31`Z ` : : -4 <br /> _v,: m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my Wi E ZS g E E ? C <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of p'• m E [ <br /> all Information contained In this application(including any accompanying schedule)and I further declare that I recognize N' '• o'w <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 1 am d <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other E m E [ <br /> authorized person to ss to the above des bed premises at any reasonable time for the purpose of Inspection. T <br /> SIGN HERE —c <br /> (sign (date) W` <br /> 7 X13: <br /> ZONING ADMINISTRATOR <br /> NNNN NNS <br /> N NNN NtttU <br /> N m�Otn NOO <br /> OWNSHIP PERMITS MAY BE REQUIRED <br /> �c 1 <br /> �qo <br /> S <br />