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Onwa, y <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 , <br /> r <br /> w <br /> w <br /> c <br /> OWNER ' TELEPHONE 21 <br /> m <br /> HOME ADDRESS dS GfC ��^f �fJ/�� Rd n 9 <br /> EMERGENCY/FIRE NUMBER /3 Z L ROAD NAME GJ/f=s� `D/.v 74 1 ~ <br /> LEGAL DESCRIPTION(see tax receipt) ,L 3 �/, cl) <br /> R� c 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION fr <br /> n <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION 0 X J <br /> fn <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) + 'a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR it if <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. PL�+ S G <br /> 5c-e- 0 c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C 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(OH WM)OF LAKE, Z <br /> STREAM OR RIVER. o <br /> 4. SHOW THE LOCATION OF THE WELL(111/),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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. fo 0 <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <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' -I-'`- L &jj_.G()m.S /Vo'l" (�ItiC¢ric�_ /ln4y '# d <br /> p JJ G ` ;a -0 m dr y O�O10 <br /> 6. f lro nJ�( �p Q�((P LC1 S0(/-0 Ur �7 �Ya �f( �fmA 1�7 (/i+ U � y 'a d ; <br /> IC <br /> it <br /> 7. <br /> o : <br /> rni i ' <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 ofCL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G <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 d ; <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to'hfil access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> H i i <br /> SIGN HERE <br /> (Alan r of o ding contractor) (d e) <br /> VE <br /> ZONING ADMINISTRATOR 91_ G` ` '• i <br /> h h w h N <br /> N N V1NN fit <br /> (ll fil O (il f71 O <br /> 0 0 0 o <br /> 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 '0000 0 <br />