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6491-)col J <br /> Z <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,W154872 Office of Zoning Administrator ,n 3 4 0 <br /> APPLICATION FOR LAND USE PERMITS r <br /> w <br /> Su/�4J �SBn rn d <br /> nn 1 TELEPHONE 3y y <br /> OWNER h/ � s/y�J 1CGr/7 <br /> O <br /> HOME ADDRESS K , L /7�/7� I✓ I J 7�7 o <br /> a37 � OAD NAME <br /> EMERGENCY/FIRE NUMBER G <br /> r <br /> n Crsr,��//Y f'//a/fh 7T' <br /> -6 a/7c-a C <br /> LEGAL DESCRIPTION(see tax receipt) Q 6 6( 07-0/L � ' - o <br /> Ce or <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE-ADDITION 5 <br /> w rn <br /> o fl/Xi <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONy <br /> tir <br /> c3L ) <br /> 6 1 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ; c <br /> T i4 <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) sac T G � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATEC n <br /> NORTH(N). m 3 <br /> 3 CEN ERLINE OFONS ROAD(C)BUILD NG(S)MEASUREMENT TOT EIN FEET OF THE FOLLOWING: (A) (ORDINARY HIGH WATER MARKT(H(WM)OF LAKE, c <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, <br /> UIL -INGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLEDrev I <br /> . o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS o <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE g ° f <br /> ISSUED. �1{ 1 <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. � <br /> CONDITIONS OF PERMIT: ` 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> CUTTING2. REMOVAL OR <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPEC FICALLYLINE. <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. <�. w 0m a 1d m <br /> r-w N 0N 3 <br /> a It w O <br /> 6. o ? w c15 I <br /> oro <br /> 7. v,: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my E i3 0 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> application(including an accompanying schedule)and I further declare that I recognize m <br /> all information contained In this app ( 9 y ` ` 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to m <br /> m <br /> sue apermit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the MVe described premises at any reasonable time for the purpose of Inspection. w <br /> SIGN HERE (date) <br /> nature of owner or ilding contractor) <br /> i i E i i i <br /> ZONING ADMINISTRATOR I N N H 40 L" N N V1 M <br /> N N ( N P <br /> N N O p1 Vt P O O <br /> 0000000 000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />