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Burnett County 7410 Co. RSI.K, No. 102, Siren,WI 54872 Office of Zoning Administrator � ' 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> 0 <br /> 14C c <br /> n Q <br /> OWNER rn TELEPHONE � <br /> m ` <br /> :� <br /> HOME ADDRESS 8 �3 ( (► C� L K r" C� 0 <br /> 0 <br /> r � <br /> EMERGENCY/FIRE NUMBER ROAD NAME CJ� 71o <br /> ( pZ9 9 � SE �1y Se_o, IS ) <br /> LEGAL DESCRIPTION see tax recei t Y ►Jq 3b9 <br /> U CD0 <br /> �( <br /> y0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING +` GARAGE/ACCESSORY STRUCTURE ADDITION v <br /> a <br /> Fn 6 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> CD <br /> {,' <br /> STRUCTURE/ADDITION USE: / ` q in c4— L rQ C Arq q 9 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) -o <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> ?� Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m 30 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). W 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 AND MEASUREMENT TO WETLAND AREAS. ) P <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. <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. 0 0 <br /> � o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q/ 1 <br /> CONDITIONS OF PERMIT: V`f <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. �ljJ <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. p <br /> 5. CAYo�Q wR5 cAerrn« cue Ing Lt�?ac+ �� A� <br /> -01 <br /> aM : <br /> n= ODov< - <br /> CD m <br /> nc m 0 as. wy N C <br /> o <br /> 7. o : m CD <br /> N <br /> a <br /> ( �� <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i. Lj-'r Cm <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of SLJ o <br /> �^ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m : m <br /> m <br /> that this information I am providing will be relied upon by the C4aanv <br /> WL9L imjdetermining whether to is- ' E ' O <br /> sue a ermit. I further acce tall liabili which ma be a resulCf i on this information I am m <br /> providing in this application. I agree o permit county officiI " e� �linty ordinances or other E m <br /> authorized person to have access to the above described pr i easonabletime for a purpose of inspection. m <br /> CDCD : <br /> SIGN HERE <br /> APR 3 01998 <br /> signature otteMr'15ufldlng co r) - (date) <br /> ZONING ADMINISTRATOR BURNETT COUNTY <br /> to v+to to to to <br /> N N� NNN (T <br /> fTON (n00 <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 o 0 <br />