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c6m cin , <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator a o 0 <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> r <br /> OWNER A/ 46he, 4_ F C�i�App,4 TELEPHONE7/'—&5J �-ffz& O .� <br /> m <br /> HOMEADDRESS ��S"'fl '7'SJDU0+1f'/'f tU.l SY-�d/ 0 <br /> EMERGENCY/FIRENUMBER �oZs'� ROADNAME (ff��Lo �.-�r� „' <br /> LEGAL DESCRIPTION(see tax receipt) _ ,S/ S J W <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE oDDITION Ir <br /> 4 <br /> 5. <br /> @. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION— <br /> STRUCTURE/ADDITION USE: &rre.a l[iaroom will Le Po yer, /'Ic7/1iAW 4d 1!/ be b rH <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) p.5 SpQ,CG 12 -1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. (Ill�gJ <br /> A � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 � <br /> T 2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). rA <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m ` o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. P <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 S <br /> MUST BE SIGNED AND DATED BY THE OWNER. m' o <br /> D <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN E q 0, <br /> ISSUED. 2 L <br /> 5�S�ynlf <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1 <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 /> PDTS, RIVV R UNLESS SPECIFICALLY PERMITTED. <br /> 5. O C—' /, Dn/ 5 1.Pay �� CP- /71D1'e <br /> ,yl/ �y J / c / gV31 . Sp� QO o 'O <br /> 6. F" mwiS `be 5eeo /)/(/ Cir ^ -Il M n 3 3F . 'o <br /> r - m <br /> a o <br /> =w: m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief It is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of <br /> all Information contained In this application(including any accompanying schedule)and 1 further declare that I recognize : IS <br /> m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is. m ; O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m E E <br /> authorized person to have accAs to the above described premises at any reasonable time for the purposeofInspection. T <br /> SIGN HERE <br /> Sig to fcisfineror ntl g contractor) dates <br /> ZONING ADMINISTRATOR M In 03w a w w H a H <br /> ' j N N O fr N 0 0 <br /> O G O 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRE �1 •_`�—_,_ __.��/ 0 0 0 0 0 0 0 <br />