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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator `-�-l 0 J � <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> �J�3 77at N ° O <br /> A ` T 61.2- 6-5'6-753.z <br /> OWNER <br /> J TELEPHONE o f <br /> HOME ADDRESS O <br /> c3 SSSx Na, koUiS Elf K.Mfl tq5#a-c 9 <br /> r � <br /> _ o <br /> EMERGENCY/FIRE NUMBER 3�j� c7/ ROAD NAME AO,e,L���y Q <br /> s� /,BN av 7w , yo 16' <br /> ?0WA, o� TA e kSe�! � A <br /> LEGAL DESCRIPTION(see tax receipt) [// L S'� ✓�f �5/ N /I r a � c <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION ' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> 0) <br /> !1/� <br /> STRUCTURE/ADDITION USE: V� elifa" &-Nk <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) � <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _n <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE NORTH(N). CSC/ o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m3 <br /> CENTERLINE OF ROAD,(C)BUILDING(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. SZ) <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE '" o <br /> �. <br /> ISSUED. aC <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c (Zf I C <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. <br /> 4 �-00r v omAn <br /> Po ' a <br /> 6. W. <br /> tc w o'0 <br /> � <br /> 7. <br /> _v, M <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; c '• p <br /> n : <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> CL is <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognize o o M <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 <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other Co <br /> authorized person a access a Abovq described premises at any reasonable t m <br /> .. � CD : <br /> SIGN HERE <br /> n re o wn r ding contractor) ( ! date) <br /> OCT �2 1 1996 <br /> ZONING ADMINISTRATOR 1 \�. . . . . . H <br /> N Ntn N N NN <br /> 00000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 <br />