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nrL <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V o 0 <br /> APPLICATION FOR LAND USE PERMITS . j)p <br /> N <br /> C <br /> OWNER Qp„�l-ii�S J f� TELEPHONE �5j.-5/Z(9 Q a <br /> Y <br /> HOME ADDRESS Z 3 0$-9 toe b �{— S/ / GST 5 y87z — 0 <br /> r � <br /> q 0 <br /> EMERGENCY/FIRE NUMBER )r��� ROAD NAME �9, 2-/j 3s— <br /> \5 2a/7-lrB/A/7 k/ <br /> LEGAL DESCRIPTION(see tax receipt) `0T C,7ot y /y p /y 9 e2.1zo rn <br /> N 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ADDITION- <br /> Cr <br /> Lk <br /> 5 x <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION � <br /> ,,// ca <br /> STRUCTURE/ADDITION USE: #ow e_ or (� <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) i <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 /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> M Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m e <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C C) <br /> NORTH(N). to _ 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)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <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. m 0 <br /> o XJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <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 UNLES§SPECIFICALLY PERMITTED. <br /> 5. l• JV <br /> f�i�i sm pp qo o MV <br /> 6. af6j•(j •{8 5 C 3F Q, MM <br /> woo ; <br /> 40 <br /> 7. Z ' a CQ <br /> o <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d C <br /> all Information contained in this application(including an accompanyingschedule and I further declare that I recognize a ' . . . <br /> PP (� 9 Y I 9 ` e �^ <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- m E O <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the ab ve described premises at any reasonable time for the purpose of Inspection. <br /> m : <br /> m : <br /> SIGN HERE w <br /> (signatureof r or b Id o actor) (date) <br /> c <br /> ZONING ADMINISTRATOR <br /> in <br /> h iN N N(AM+ <br /> N NfnNN Nut <br /> N NOPP00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 o g o <br />