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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v-0 / o �o <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> a o <br /> N � <br /> OWNERacaer S�/L u/O /J TELEPHONE $' <br /> �V CsI` o ii <br /> �+ �7 8 �LJ <br /> HOME ADDRESS NS <br /> /�S 134QOm / foA / I ) /S zoo M10Vglel'V/r11✓ v 9 <br /> EMERGENCY/FIRE NUMBERTL ay ROAD NAME l 1Eu/ nSQsI Zo <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) 5°E% (� y S�°C h0 32- IV-4 �8 W 0) <br /> 'Sq#3 row c nt u -7 , S (A1. <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—X---GARAGE/ACCESSORY STRUCTURE ADDITION C <br /> o. <br /> 5. n ` <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> m � <br /> )U sjirn h3SErn� <br /> D <br /> STRUCTURE/ADDITION USE: I'fO M EICnt�ll✓ On4z,2 !7 `e <br /> — <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) -) � <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) 0 $ <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S :b2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO tto .. 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, I LV <br /> 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. I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS S <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 0, <br /> ISSUED. a <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 r'\__) lJ� <br /> ISSUANCE. IN <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 /> �. d d m <br /> 9� 3 n A <br /> 7. Z a 'a ? 1 <br /> o A <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my g p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize 'e E I ': 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 Bumett 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 above described premises at any reasonable time for the purpose of Inspection. T i <br /> SIGN HEREcn�-, <br /> (s osttury of owner or building contractor) (date) E <br /> ZONING ADMINISTRATOR <br /> HNMNM� <br /> N N N N N u N <br /> rT ut O fa P% 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />