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e,-Y ' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> CD APPLICATION FOR LAND USE PERMITS 3. <br /> N � <br /> N <br /> 'R�l�C(Cc_.�1, 1fC,�,, <br /> OWNER W Q..n M I U TELEPHONE b I Na 4 59- -3Z9Q n <br /> v N <br /> 1I CD d <br /> HOME ADDRESS 77,;Iq 39 6i. S0 . (��6e �Uvc fv�Mn, <br /> EMERGENCY/FIRE NUMBER (t V ?J-V.4 36'(?t?ROAD NAME <br /> MG-�ilyn Glenl-��n � e ✓ <br /> LEGAL DESCRIPTION (see tax receipt) X b I Q q 1 c <br /> �) C <br /> TYPE OF PERMIT(S): DWELL ING/BU ILDING---)LGARAGE/ACCESSORY STRUCTURE ADDITION C <br /> SANITARY PRIVY FILLING/GRADING� CAMPING UNIT SUBDIVISION 0 <br /> Cn <br /> C ►t� r <br /> STRUCTURE/ADDITION USE: I J � 1 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck,etc.) 'a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m '3 <br /> - <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p o `v <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS (NB)AND INDICATE <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 /> 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. <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. <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEa o <br /> ISSUED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. \`O^ o t <br /> CONDITIONS OF PERMIT: \ V <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER AAcc <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORE? %�``` V <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICAI-I��(y' <br /> PERMITTED. ` <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 fi CHUJA �. <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. pli <br /> pvO � �Doyo <br /> 0 3nm `s � <br /> 6. v c - <br /> fU C N N O O 3 <br /> N N O O <br /> 91998 z : ID <br /> 7. P ° cn <br /> — a : m <br /> I declare that this application (including any accompanying schedule) has been ex [r�' o my ti 3 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible fTft L racy of a <br /> all information contained in this application(including any accompanying schedule)and I fu 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- y : Cl <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other W m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> (u <br /> CD <br /> SIGN HERE <br /> 046- <br /> (signs re of owner or building ontractor) date) <br /> ZONING ADMINISTRATOR <br /> �to cn cn cn to <br /> 0 1 0 0 0 _ 0 <br /> CT N O N ()t _ O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o O o <br /> 0000000 <br />