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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator Z <br /> APPLICATION FOR LAND USE PERMITS 3 4 ° <br /> 2 <br /> OWNER <br /> y� <br /> arm yy Lo t l l Cp(M S TELEPHONE i ya <br /> _ g - �g <br /> HOME ADDRESS l -3 0(0 1 K V t' nq ` � <br /> A-o-c�; , ,� � P, M n s 5 L/ 3 <br /> �( <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME /+Loy 1 � � 1 <br /> )I-LEGAL DESCRIPTION(see tax receipt) <br /> S I T41 R)S LA PCL 14 Lf r I S, l 3 (34 ':x-oc) I co <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE�ry <br /> nnirinni o <br /> CL <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ' <br /> r _ <br /> "STRUC URE/ DITION US <br /> (Hom abin;Commercial Business; Bedroo ; Deck;etc.) <br /> A PLOT PLA N MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR r. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _n <br /> 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING? (AERIAL OR TOP VIEW) 0 2 <br /> -n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m j <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(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. W <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 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CANBE 9 S1 <br /> r <br /> ISSUED, <br /> � a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> I <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 rSPECIFICALLY PERMITTED. <br /> 5. Aice55rr0 <br /> QM )��Ij u pb6 OVA, <br /> VA, 0-, hkn ar W AAij� <br /> Mmo ok <br /> o -a <br /> 6. } yaSork Z_IN ( pa s0 >Qa <br /> C <br /> 7. 2 as <br /> o0, <br /> -1 <br /> _Cn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ` m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m m Ei ': m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- G'S 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 ^� <br /> d <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other CD <br /> authorized person to have access to the above described premises at any reasonable <br /> m : <br /> SIGN HERE i " "-2-4 a '7 +� <br /> (a to ofowneA�or contractor) (date i <br /> ZONING ADMINISTRATOR A 3 11997 <br /> 40 <br /> w <br /> V <br /> a Ul M111)Cn 0 0 <br /> �. N N fNA OOTOWNSHIP PERMITS MAY BE REQUIREMM o 0 o 0 0 <br /> 'L�.____ _ . . _ __ <br />