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C <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> N � .y.J <br /> N <br /> fly' I _ N <br /> OWNER 1 l! CJS �L l CiTELEPHONE '71 �(C{ J <br /> t <br /> HOME ADDRESS 1O{ P,O C-�Cc <br /> VjCD <br /> EMERGENCY/FIRE NUMBER 3 ROAD NAME (6 h 0 n, <br /> LEGAL DESCRIPTION(see tax receipt) rn <br /> n <br /> N <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAG ACCESSO�STU ADDITION- <br /> SANITARY- <br /> DDITION SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> n .jfo�rvl S t' + l) m <br /> STRUCTURE/ADDITION USE: &s ie t-�-NC' -,* Co.4ae Sfd6S+�c (.51f n,✓l/i� /VA� -tex'\./ a rb <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) S(!-L6fP'_ m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 tom' <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p " <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> _n O z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 5 m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m !" <br /> NORTH (N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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. l� <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 Z_ <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> _o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE `" ° <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT n ) <br /> ISSUANCE. x <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY j S <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, r <br /> PONDS, RIVER UNL �SPECIFICALLY PERMITTED. 9 d � r� olb <br /> 5. <br /> CD rn <br /> 6. YlGr1, v m c W 0 <br /> NtJ�e SQL 1 v$ Qr��c N�7-S C z y CD ° <br /> 7. o rn <br /> M <br /> I declare that this application (including any accompanying schedule) has examined by n st of my c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I spon for the deta I c ^racy of o <br /> all information contained in this application(including an accompanyingsc ule aieydeclare that I do nize �' <br /> PP ( 9 Y ) te;tt g fD 1D : m <br /> that this information I am providing will be relied upon by the County of Burns�Q Consin 01 At ng wh her to is- d D <br /> sue a permit. I further accept all liability which may be a result of the County o'/ Ing on tfiFS info a on I am m <br /> providing in this application. I agree to permit county officials charged with admini ordina or other m <br /> authorized person to have ove <br /> cess to the abdescribed premises at any reasonable o pection. T <br /> m : <br /> m <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR . . . . . Fn <br /> cn Fn t»t»to v+ <br /> N <br /> PPTCA PfT NN P <br /> (n 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 o <br /> 0000000 <br />