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vJ� <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o° o <br /> St APPLICATION FOR LAND USE PERMITSbi <br /> 3, 4 <br /> r <br /> OWNERVvR L AD(✓ OF RPFTyAC f7r�Lf2 C, PHONE 6s 0 <br /> m <br /> `"� ; IF <br /> HOME ADDRESS MA/N t R O AAJ13 f/R.1' , yy 1 �� 9 <br /> EMERGENCY/FIRE NUMBER ROAD NAME �I�i�sJ-SFT' ll�tJ <br /> �}fL QG 8 LoT.5 4)Zi S i'1 , 4:- r <br /> LEGAL DESCRIPTION(see tax receipt) J, �jr/ NW x, S GT r'ql A,/ R A „/ C <br /> 'T /�' o <br /> y <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE CCESSORY STRUCTU 1/ ADDITION_ Cr <br /> CL <br /> La <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> 0)0 <br /> STRUCTURE/ADDITION USE: 57-CRA6e- <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> � a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o UI <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. d o <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. o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a 0 <br /> ISSUED. ^, I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: h Q} <br /> 1 h 1 <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 /> A6. mor, QO9Ore <br /> a Ch w c E 3 <br /> 7. Z : a m,Z i �m i <br /> o : <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my c 10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of e E S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C m E E <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is ''``,,' m `: 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> SIGN HERE /1 A• n '14 <br /> ( na a of owner r ilding contractor) '__(date) <br /> I �� <br /> ZONING ADMINISTRATOR I )i i '• i `• <br /> � wwwwfnfn+ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000`000 <br />