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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS st a 4 <br /> ^� r <br /> I y�n r/ N 0 <br /> �JC(/rYI <br /> OWNER e-s I� (�L �'O ' I''I / i1II WISP✓I TELEPHONE r/7 I�_- <br /> _/ i? L 2 d <br /> HOME ADDRESS 1 (7 (o 3� �GZ!•'CL'GL�'l Kd �l OQ.h1 Jll r21 W. 3n ��• C/, ��X \ � � <br /> EMERGENCY/FIRE NUMBER q 3 ROAD NAME PU ydV,, k9d j 1 <br /> Gof 7. Ri L'et'S,�e f1��e5 P -7 u�HV 3�i 8 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE"DDITION c OF <br /> ' <br /> Cr <br /> L1 <br /> 5. <br /> N <br /> SANITARY—PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED 07A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n – <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING? (AERIAL OR TOP VIEW) p RL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2 SHOWNORTTHE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m z <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <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- (� O <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. c <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEa o <br /> ISSUED. � i <br /> I ', <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z I <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <br /> ISSUANCE. �J O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3 NO GR <br /> T D.NG OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PEQ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. r I a <br /> 5. <br /> 6. 3 RL ek % <br /> n m <br /> a 10CYri41o7E <br /> 7. C0 m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <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 I a ? m <br /> that this information 1 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 inlstering county ordinances or other <br /> authorized person to have access to the above described premi a u ose of inspection. <br /> o <br /> SIGN HERE1� .+q ti <br /> (signature of o or or building tractor date <br /> MAY 14 <br /> 1999 � ( ) <br /> ZONING ADMINISTRATOR <br /> RNETT N N(7iNNIJiN <br /> Oi VtOUNOO <br /> TO SHIP PERMITS MAYrE RE�j G�NTM 0 0 0 0 0 0 0 <br />