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N C ao`P, <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER -�ry�n � f'rJ�T���G� TELEPHONE <br /> � I� ly 1 O <br /> HOME ADDRESS c{ ^L!J1'ir /OiL�, j s �� 0 <br /> m <br /> EMERGENCY/FIRE NUMBERye ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) 6x6)6/ r Sf C/i 0�f1 �' (a <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION cr <br /> a <br /> 5: (1 <br /> N �.l <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: e i ( C / ��i-)G <br /> (Home/Cabin; Commercial Business; Bedroom; 13ck;etc.) i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. gm ^ <br /> A w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> MZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m W � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). to c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO nn v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, rnI� Z <br /> STREAM OR RIVER. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- 9j <br /> INGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 1 <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. m o <br /> o 0 9J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BECr ° <br /> ISSUED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z 1 <br /> CONDITIONS OF PERMIT: P <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. 6 L / _/ 5,,#A-1 <br /> S1 /C 7 �/n�' (r fX ly7 f(3 <br /> ;o -u m r 10? 0 -0 <br /> 6. 3 a It m <br /> CsAwo � � <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; 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(including any accompanying schedule)and I further declare that I recognize : m m E ' M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- <br /> sue a permit. I further accept all liability which may be a result of the County of Bumett relying on this Information I am �_ _ m E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to ve access to the above described ss at ny reasonable time for the purpose of inspection. n <br /> m : <br /> SIGN HERE <br /> (s Ictu a of owner or Ilding contractor) <br /> v, '' <br /> ZONING ADMINISTRATOR <br /> wfnwwuw� <br /> Mal I <br /> N N V1NNfJ1 IT <br /> V1 . . . N. . <br /> TOWNSHIP PERMITS MAY BE REQUIRE[✓{i},�i Y T I�'I o 0 0 0 0 0 0 <br />