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& &Y/�Oj <br /> Burnett County,7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator T o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> w <br /> ^T' UiA o0 <br /> OWNER MQY'ShQ�` b J AaV 1 \ t ' 1 TELEPHONE b S'(D 3 15 O a <br /> Boas „a R e . Q)a� 1(0-b 9 <br /> HOME ADDRESS V �� <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) �0•ll � ' Nfadi< Ori 2 . wr\3 i,if_ N\64 ap /^ <br /> �! yT o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE Ilk ADDITION Crgi <br /> Q� <br /> 5 <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ;G) <br /> STRUCTURE/ADDITION USE: .Jkof o.2,Q_ 5W S� �{�'Q Er <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> � w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T v <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. S �A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(N). co <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> P <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. ° <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. n 1 <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 i <br /> MUST BE SIGNED AND DATED BY THE OWNER. 9 41 <br /> v61 <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 .:;P6O C1 <br /> CONDITIONS OF PERMIT: 7d <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 <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 /> M 'amm vL <br /> a <br /> 6. 91 m <br /> !A <br /> 04 <br /> 7. Z w310)i i <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS g ; C <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(includingyreof <br /> panying schedule)and I further declare that I recognize o 'm m <br /> that this information I am providing will be relied upounty of Burnett Wisconsin in determining whether to is- m v <br /> Is- <br /> sue a permit. I further ac ept all liability which may bthe County of Burnett relying on this information I ammproviding In this applle I ag a to permit counharged with administering county ordinances or other E �authorized perso acces the a descris at any reasonable time for the purpose of Inspection. m <br /> e : <br /> SIGN HERE <br /> Sig ature of or ding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> Cr1H NNfa NH <br /> VN N O N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />