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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administr to �� o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER �t C,I w �"C �j(�s k I TELEPHONE V <br /> m <br /> HOME ADDRESS Z ( C Y f/L/ , �� 0 <br /> EMERGENCY/FIRE NUMBER o ROAD NAME V v I W <br /> ,A/ it1 _ _ <br /> $ Ec, z Tk'N 3k l J'w Yo o <br /> LEGAL DESCRIPTION(see tax receipt) �� (S AFF :52F 5GO!z w �cl &s120 L 0 <br /> f� o <br /> a <br /> ca <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE DDITION <br /> CL <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> co <br /> STRUCTURE/ADDITION USE: -1 'Y30, <br /> ylir <br /> (Home/Cabin; Commercial Business; Be rolmm;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O(eY I `� A+,S 4t�� 0 w <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 4'K. �,+1 0 a <br /> 1 .ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. V 1� <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). to 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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o p <br /> q � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE " ° N <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW, c f <br /> CONDITIONS OF PERMIT: C <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. <br /> 3. 0 <br /> sb � ag <br /> 6. 3a : CH m e 3 <br /> =o' m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my IQ <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- \ ' D <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 applic n. I pgree to permit county officials charged with administering county ordinances or other m <br /> authorized person to acciilles to the q6ove describegpripiJIM a 1 he purpose of inspection. T <br /> m : <br /> 7 m <br /> SIGN HERE !/ . <br /> gn ure of wn or buil ng c ctor) (date) <br /> ZONING ADMINISTRATOR A <br /> a 0 fa w <br /> TY <br /> TOWNSHIP PERMITS hWWFR 4 0 0 0 0 o <br /> ZONING <br />