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6y) Int„"L" , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 Z <br /> 111 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> wo <br /> 6; ir, Int ILLI-P(1a5 <br /> OWNER -h)(1 , , � <br /> � � TELLE,P�HON IY! [5): -_ <br /> 2531 a <br /> HOME ADDRESS <br /> 5� � <br /> 1 O 1 <br /> EMERGENCY/FIRE NUMBER 52�iO1 ROAD NAME l,l�/�IY� � ��rY,J Li <br /> W lAvol 011-j 22pS OS 680 <br /> r 9 <br /> LEGAL DESCRIPTION(see tax receipt) 2::3S -f'1 /�M <br /> 1G—r) 05Lim G'5M V 17, p� � y <br /> u ��--iJ Ven. — <br /> N Q <br /> ��// o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING--It—GARAGE/ACCESSORY STRUCTURE ADDITION,L� a CL <br /> n <br /> 5. v <br /> w. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION v a <br /> m <br /> 7� n ��t n 0, <br /> STRUCTURE/ADDITION USE: t�eIJ1 l fir 3E <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) v -C i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR n 3 w <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> xw -a cc In <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 IV <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). m N 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <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,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. nol N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS p <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> _v. 9 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 jf <br /> ISSUED. <br /> r o <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o p <br /> CONDITIONS OF PERMIT: i <br /> I✓ <br /> W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT l rr <br /> ISSUANCE. CD <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. NO & Jl m ov remo ck &.N- tit e h-r SVeery W> *V �-10�o)V-- sn�rn ' M v o� o i o v <br /> �. � <br /> g, SEE VARIAN #584 c w 0 o�' 3m <br /> wo as <br /> m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my 10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 1e m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- '• 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 '• B : E <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 r asonable time for the purpose of inspection. CD <br /> m <br /> m : <br /> SIGN HERE , ` • 7 A,137 H <br /> (si re of owne or��uilld�dinlicontrac r) (date) <br /> ZONING ADMINISTRATOR 7, /�C%�l — e �' <br /> to twwwwrn� <br /> � iro�cNiioo <br /> TOWNSHIP PERMITS MAY BE REQUIRED 90 0 0 0 0 0 c <br /> 000000 <br />