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01� C <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator Mo 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER L HAR L ES Ir I L)A I TN h(AHL 6/2 TELEPHONE 7/S_3 S L b'Z.6 / m <br /> _ $ O <br /> HOME ADDRESS 116,? 6 � 57 /-/upso,v o W <br /> EMERGENCY/FIRE NUMBER 4 1,qq ROAD NAME w ARA/EC LK. R D <br /> pc/ /h. <br /> LEGAL DESCRIPTION(see tax receipt) ?- Lc 7- E Sc=C �TGvvsrt,P 35' AJ�Qrr+�RJS I <br /> y <br /> o (�l <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION or ✓� <br /> CL <br /> 5. <br /> I@. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION `; � <br /> m <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Com rcial Business; Bedroom;Deck;etc.) j <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p CO, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> ?i G Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m jo <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). (n O <br /> 3. SHOW DIMENSIONS IN FEET-9F THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rn I \�A 3 <br /> CENTERLINE OF ROAD,(C)BOILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. ° <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. l <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 9 CJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE g <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o D <br /> CONDITIONS OF PERMIT: �y <br /> � 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT _ <br /> ISSUANCE. I (� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. rn <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. y <br /> CS22 � m <br /> to �iF n <br /> 6 v ' C7. <br /> wwo � 3 <br /> i i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ej c p <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o. <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognize o E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is. '• 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 E m E E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. n <br /> W <br /> xA.l�.C�.. <br /> SIGN HERE ` E <br /> ( n tura of own or uliddiing contractor) (date) ' <br /> IN <br /> ZONING ADMINISTRATOR �� c,a�,.�, 4, <br /> Cn <br /> H <br /> ON NN NNf)I <br /> U N O V 7 N O O <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 00 <br />