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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 _ <br /> N <br /> OWNER / %SJR �J n AhSOn TELEPHONE G- <br /> / p p /� � O <br /> HOME ADDRESS J�Z3 EW no .4th / Aeeek�irn JA4 X.", <br /> 0 <br /> EMERGENCY/FIRE NUMBER a 7 q4, Ll ROAD NAME <br /> S 3S Tya/R!S <br /> ae cs / IFX, <br /> LEGAL DESCRIPTION(see tax receipt) 140 -t�-.35 '500 <br /> pL4L10Ga✓ 4`t- Al Fy 1 V-3 6 E" fPCgel <br /> o) <br /> C') <br /> _ <br /> y <br /> o O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ✓ ADDITION c <br /> Q. <br /> S. <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> N <br /> STRUCTURE/ADDITION USE: Aif'�Q� O � i/r � r'H!! � I <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETF OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Or)C`�fr- /j v O� 0 (�J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) I w O `(d f G(J� O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. S <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M O <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> 0 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 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- <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. m' <br /> v � <br /> NOTE: BUILDING/STRUCTUREOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. �S ftf�, In I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. e o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3.---UO 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 SPECIFICA.L{(..(Y,-PER�fITTE(D�. /� `/ <br /> 5. NO vcttl � BNWL1lW�`� MG//�+✓f1'eZt x -uor- oto -a <br /> 6. J✓Isl(� �U e. 730 �M �'ONt Pry/_ ~I '`� v Cw o w E r <br /> 7. o i c q <br /> _Cl) <br /> m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ii E <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m .. m <br /> that this Information I am providing will be relied upon by the County-of Burge scoasin is slag whether to is- O <br /> sue a permit. I further accept all (lability which may be a result of the-Cky�td t I � Ii l formation I am <br /> providing In this application. I agree to permit county officials chart ith Oji IQ <br /> �[j u �ces or other ? m <br /> authorized person to have access to the above described premises a reasonable time or a purp a of Inspection. -n <br /> CD <br /> r� i <br /> SIGN HERE '" 2 <br /> ' (s�ure,ofow wilding contractor) e) <br /> BURNETT COUNTY <br /> ZONI <br /> ZONING ADMIN( RAT <br /> NG N 40 <br /> (HJ1N4A <br /> fNJ1 Vt <br /> frl V7O N NOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />