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r-), C4--mp <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 O Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> Q f(� <br /> � / R <br /> 1 ' 1 <br /> OWNER pQ(Alyi n'E4+4—p JA ��(TP,S I d-p TELEPHONE /� �� — "(Q Cf 3 m <br /> HOME ADDRESS 3 �?� 4 �+ d �Ll✓tDLt I S�g3D ') /�� �y <br /> EMERGENCY/FIRE NUMBER <br /> '313c l� ROAD NAME <br /> —r l <br /> LEGAL DESCRIPTION(see tax receipt) n y <br /> �J m <br /> N <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION Q <br /> n <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 \ <br /> STRUCTURE/ADDITION USE: <br /> X 30 d <br /> Er <br /> (Home/ abin; Commercial Business; Bedroom; Deck;etc.) ` <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR _1113 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> rn <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) p m n\ <br /> n a w <br /> 2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n eo <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m (D <br /> NORTH(N). <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, 1[J <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. v 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. :E O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 0 ( <br /> 0. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q G U` <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° I <br /> 6 <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 /> A -V0� 0 0 .0 <br /> m <br /> 6. .0 m C m ^62 3o ' 3 <br /> 7. z ow ?,' —I <br /> p <br /> (� — a,: E m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my v i Lj c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of � m S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m 5 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- S: 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 'm <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 /> m : <br /> m : <br /> SIGN HERE /;2 e f1/iryl S �` <br /> (sig ure atof owner or building contractor) (date) (Y..k <br /> ZONING ADMINISTRATOR /riQ�Z� u �; <br /> 69 40 4a 4.9 <br /> N N (IINN (T CT <br /> Vt Ut O ut N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />