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997 / <br /> Burnett County 7410 Co. Rd.K,No.M, Siren,WI 54872 Office of Zoning Administrator -0 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> p �C q y/� �j <br /> OWNER Gti i170�T00 ���)O/11� ��7/fSbwT-ELEPHONE K, S g7j 9v <br /> m <br /> O <br /> HOME ADDRESS <br /> Y0 ,55 <br /> 0 <br /> s 5 yah <br /> EMERGENCY/FIRE NUMBER ROAD NAME Z <br /> LEGAL DESCRIPTION(see tax receipt) IE �� 1 3 �� be v' <br /> TYPE OF PERMIT(S):DWELLING/BUILDING--If! GARAGE/ACCESSORY STRUCTURE ADDITION rr ` <br /> H. LI <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> _T <br /> VJ � <br /> Ir <br /> STRUCTURE/ADDITION USE: <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 c. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. A <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) CL <br /> n <br /> '-1 o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m Ir <br /> 0 '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). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGBUILDING <br /> (S)TO ALL LOT LINES, (B)BUILDINS)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. I o <br /> 4. SHOW THE LOCATION OF THE WELL(V),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILDJA <br /> - <br /> INGS,ROADS,LAKE,LOT LINES. CKS <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS i 3j <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 a ° <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c Rl 50 <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT L <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. = m? oiL <br /> 3 aIt QI 'm <br /> 6. co 0 <br /> Z E. <br /> i i <br /> 7 0 <br /> C0: i 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 ii E <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize e : : 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 'm <br /> providing In this application. I agree to permit county offjctals charged with administering county ordinances or other ' i m E E <br /> authorized person to have access to the above described pn'etr+isen atatry reasonalZl_e ti <br /> i <br /> SIGN HERE <br /> (signature of owner or buildingontrector) rte, i Sgidfe- 1L• <br /> ZONING ADMINISTRATOR <br /> N NN N N N N <br /> fT Vt O to N O O <br /> 0 0 0 0 0 0 0 <br /> TOWNSHIP PER .. - ,_ �EQUIR,�_ ED - M ��0 0�0 <br />