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M cv 'T' ' <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -lit o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> � J C C'3 <br /> OWNER a� // ✓�� I SCh TELEPHONE <br /> JJ m <br /> 1 <br /> HOME ADDRESS j L�3I$ 0 Sf f J -f,r�IL wn mar..+{ MN. 5"Saf7 CD <br /> 0 <br /> � <br /> EMERGENCY/FIRE NUMBER ROAD NAME 491'1//Cfl <br /> Dr,' <br /> A PC&rC-fC of Gov , io-f �f See . z3 Ti«jefl.;f _. <br /> LEGAL DESCRIPTION(see tax receipt) y� /✓Q, /91 f f.K S aS D ca (� <br /> 0#1 Pa,-c R69 ✓o / j t:<PfiF' S�/'y pt r�Il� 13Yrdc-ft eo elr of !/�. S 6f ,i'� p 1 <br /> N 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> Cr <br /> n <br /> w' (� <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: . Se^<Ort gwec 1. . <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) c <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 6 ' ',a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y `3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. l <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: 7� <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 PERMITTE <br /> er <br /> 5. rush, -.- (,,yam.-- preSSL" 5 s .olloL,,d t-- A-(X e r�.ti16/ SAn��n �err�. <br /> ^ k^ <br /> m <br /> 6. ¢ tin �7 ar �.ar� dUo C�os� { 3 <br /> 7. PZ ? w Sq '': 1 <br /> _tn ."0 <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n , <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- t7 <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 m <br /> providing In this plication. I agree to perm my officials charged with administering county ordinances or other m <br /> authorized p the ove des abed premises at any reasonable time for the purpose of inspection. .n <br /> SIG RE <br /> or g contractor) (date) <br /> Z ING IN STRATOR ' . ' ' <br /> 1� N tr O[Nil BOO <br /> TOWNSHIP PERMITS MAY BE REQUIRE ^�- 0 0 0 0 0 0 0 <br />