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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator /a <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> O <br /> OWNER - 7' �y� -Sd� TELEPHONE <br /> Wyoml� , m � � O <br /> HOME ADDRESS <br /> ' c � <br /> EMERGENCY/FIRE NUMBER 97-S-G ROAD NAME <br /> 4or do 7 <br /> LEGAL DESCRIPTION(see tax receipt) 7u p, yo �� a,�J /goo /4V'0u/yS 'ge"Of4t PA/F-S C <br /> a <br /> m 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION cr , <br /> CL <br /> 5. <br /> N <br /> SANITARY PRIVY FILLIIG/GRADING -CAMPING UNIT SUBDIVISION 0 <br /> oda lax( u, <br /> STRUCTURE/ADDITION USE: <br /> b <br /> (Home/Cabin;Commercial Business; Bedroom; Keck;et(;.) � <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> LI <br /> � c <br /> iRE IONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). N o <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. W <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- 1 9) <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. <br /> W v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q ° I <br /> ISSUED. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c I <br /> CONDITIONS OF PERMIT: _ V <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 Q <br /> PERMITTED. 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFI A/LLYLPPERMITTED. <br /> 5. 9/I 7/70 iT ✓Zry eU Se/�c� M 'a 0 r 0 0 O <br /> AI /� aM, y M <br /> 6. /UO ��•u�fu. Cv� tN �j/ .J d M U� /Cd '8cr- v'� C w w c 9' 3 <br /> 7. Z : Nom =mo i <br /> a7 <br /> -y : i i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and 1 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 O <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 CD <br /> a <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> CD : <br /> 7 cy Q (D <br /> SIGN HERE <br /> ( natu of owner or bui ding contractor) (date) <br /> ZONING ADMINISTRATOR w <br /> �40HHhH� <br /> N N N N (71 fJl <br /> V1 I710NN 00 <br /> 0 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />