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6y)ml <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,YON41MMPUTEfZ ' ing Administrator -V a o <br /> APPLICATION FOR LAND USE PE I 3 <br /> F 0 <br /> CLc <br /> OWNER c� //(rS T L��d r o` TELEPHONE �b R 7�-�—� <br /> HOME ADDRESS Za'�1 )0_6 h iIu.rn. i'(-•�3 lY.l.� L l-YM' w-L I v 9 <br /> / ' ! ) ti 1 <br /> EMERGENCY/FIRE NUMBER l ROAD NAME ��yu Lh. I <br /> LEGAL DESCRIPTION(see tax receipt) l D �of dun V .2 )0 7 7 ' J 0 N��! (� <br /> �) o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING��GARAGE/ACCESSORY STRUCTURE ADDITION n <br /> / I Z'S�SL_ 0 .5� N. <br /> SANITARY PRIVY FILLI G/ q�ING CAMPING UNIT SUBDIVISION <br /> C <br /> d� � <br /> STRUCTURE/ADDITION USE: I/ �+ <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) �C � <br /> w <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCPLETE OR SC��T O 3 <br /> e <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Cj�e �y M:Jp'` 13900, rorf,,._ 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 1555,X. �Fo W On ii <br /> t. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m ► ',a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). m 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 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. 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 � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 61, <br /> 1� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <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. ;a -00r. C?tCm <br /> v 6. Cw . 0 5 3 <br /> w o O <br /> 7. P : H :?1 m : 77 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my `: g C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of Gl ; 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- y <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 w <br /> authorized pepeiqo have access to the above described premises at any reaAgonable ti <br /> n;� w <br /> SIGN HERE <br /> (s ure of ow r building contractor) : , date) { <br /> SEF 41957 <br /> ZONING ADMINISTRA R w w�,d+w <br /> 40 <br /> (A 0 <br /> I i NN (TUI <br /> Vt 6 6 0 6 0 <br /> 36 , <br /> 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIREDLO O O O O C O <br />