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Al cyl�_p <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator a 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 9s <br /> �* r <br /> w <br /> � w <br /> OWNER M hlM /N�' JC• U TELEPHONE o?1S" 1p2Z1 'd5Pjj <br /> v <br /> d <br /> HOME ADDRESS $�91 p L10 1&e:;e 5 qUl e.."//J Ina 0 <br /> Q � o 0 <br /> EMERGENCY/FIRE NUMBER �Q 6 3,� ROAD NAME f4/0PC I� " <br /> 9'a__37 C.S C'& 1 <br /> LEGAL DESCRIPTION(see tax receipt) Tq/) 1 h 1 <br /> Coa 4L <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—XC—GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> a <br /> w• <br /> SANITARY PRIVY_-FILLING/GRA�DJING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: (/" � T�iy <br /> ome/Cabi ommercial Business;Bedroo ;Deck;etc.) <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ,. <br /> OtiSI .7 �� f ;0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) 5����� 6 !�J / � p � <br /> GHQ T z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0S <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C 0 <br /> Ca <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. 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. LQ <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 c <br /> o `0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <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 OZ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNIJESS/SPECIFICALLY PERMITTED. <br /> 5. �[57/Yk l�l�in//fa*G hC /c��lotF �a � y S �Ur S� v1 <br /> W n l ;aMC) oho a <br /> 6. ie � 03 ;M0a Cw w o 1C <br /> w <br /> P <br /> =yi m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my c : ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d E ? I r- <br /> ail information contained in this application(including any accompanying schedule)and I further declare that I recognize iP w p <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 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 a <br /> authorized person to have access to the above described premises at n opabnspectIon. <br /> SIGN HERE ! `p <br /> (s na reof e r ng contra r) (date) <br /> ZONING ADMINISTRATOR &I� 1 O WT <br /> t-coo)TOWNSHIP PERMITS MAY BE REQUIRED i o 0 0 0 <br />