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C" C' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v Oz <br /> APPLICATION FOR LAND USE PERMITS 3. 4 <br /> I- <br /> a <br /> � c 0 <br /> OWN ERCarC'na O r�1 1,e ky� r.r S TELEPHONE �(i S��c7{� 7S o�3 B <br /> m <br /> HOME ADDRESS 0 �' tl� C O���.1 G` syy 76 � <br /> r m <br /> EMERGENCY/FIRE NUMBER Q I(0(p q ROAD NAME %radSlw jar ' <br /> %4t'-&Fj i p 1^ w `� GV � <br /> Ya rnG1 jhSel+h S L.h 1 \ <br /> LEGAL DESCRIPTION(see tax receipt) E h a✓ 1-O i-I W/ 1-V,151%r -ft bor V-,,W 'T 14 W le4f <br /> H % \ / I oc n r e.0 Zh 511 -Tc; Tcobol- L^ m G <br /> L.4 7o 'T 6F 6a <br /> TYPE OF PERMIT(S): DWELLING/BUILDING�_GARAGE/ACCESSORY STRUCTURE ADDITION � <br /> c <br /> CL <br /> 5. <br /> m <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> ca <br /> STRUCTURE/ADDITION USE: V�Q"\e, Ir,b I I r\ :03 0 <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) -I 7 <br /> ^e <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 U, <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In c. <br /> DIRECTIONS FOR PLOT PLAN D AWIN (AERIAL OR TOP VIEW) 0 $ k4_ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S i0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C Q <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF.LAKE, Z <br /> STREAM OR RIVER. c <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. S c <br /> v $l_) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c .. Q <br /> CONDITIONS OF PERMIT: <br /> 1 ISSUANCE. <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �1- <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 /> O <br /> xM t7Tr <br /> 6. 1is ;MV7. o. m <br /> P : �� <br /> =or: m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 m <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 above described premises at any reasonable time for the purpose of Inspection. - <br /> o : <br /> SIGN HERE <br /> (signa of owner bf building contractor) I i i (date) 49 <br /> ,�1 <br /> ZONING ADMINISTRATOR <br /> � NMI ' fJ f�JI NN fin V1 <br /> ill N O fJ1 V1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 000000 <br />