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0'�/T Cid <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0o 0 <br /> APPLICATION FOR LAND USE PERMITS __ 4 <br /> r <br /> N0i <br /> c c <br /> OWNER <br /> Ui4V;.a TELEPHONE� /Vcic>tis'©n� .1.10 ' <br /> C� <br /> O <br /> HOME ADDRESS 7033 Ik c.J q/Z o I—AI✓G ,�'o%,J �irA /Yi C- ON Al O <br /> ss3 y6 .. <br /> EMERGENCY/FIRE NUMBER ROAD NAME '41p00s <br /> 7"AA/4. wia� <br /> LEGAL DESCRIPTION(see tax receipt) �' f �� C — c2 t Cl) <br /> Gcic'CZ- 1!C <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION l� c <br /> n <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING NIT SUBDIVISION 0 <br /> I <br /> STRUCTURE/ADDITION USE:� �/ �/ 11�I`�C�l�'1 6P <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR I <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <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 O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, z <br /> STREAM OR RIVER. c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- G <br /> INGS,ROADS, LAKE, LOT LINES. 9 <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 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. i r <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <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, G <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. �/ I <br /> 5. �o+s CfrN Ala L_oK-`5' be- Sotd S��ru -�k� OU9r l a��1�...r. A v v v v m <br /> em <br /> Has <br /> 6. 91C� o � 3 <br /> N O a] <br /> 7. o i F (D i <br /> __N�. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my v( ': 6f Crc 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 a E <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- 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 CD <br /> 2 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> CD : <br /> SIGN HERE s, <br /> S- IF- 91 <br /> (SIg u of owner of it ng contractor) (date) <br /> ZONING ADMINISTRATOR <br /> wwwwvwlift <br /> � <br /> N N0 N Nfn 01 <br /> 00000100 <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 00 00 0 0 <br /> /'9d/7 <br />