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6�>L C'- rL"o <br /> Btrnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0z <br /> APPLICATION FOR LAND USE PERMITS 3 4 ° <br /> 0 <br /> OWNER �G {� JG h!'ISG� /�J�r1f\ INI�IC�1IA TELEPHONE C Ci �� , O / �'O�J�O o <br /> HOME ADDRESS <br /> w, 9� S . aa� ori v 3 <br /> EMERGENCY/FIRE NUMBE 2 ook734ROAD NAME L q X(f r j ve_ <br /> L 61 l <br /> Soh Set � y E5't�f f e's ' \ 1 <br /> LEGAL DESCRIPTION(see tax receipt) D 1 � (S;01// I- U 1 �7 Va N l q w,. <br /> � � � <br /> T T / f" Cr <br /> TYPE OF PERMIT(S):DWELLING/BUILDING11""'GARAGE/ACCESSORY STRUCTURE ADDITION <br /> o- <br /> !" a <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> t co S <br /> STRUCTURE/ADDITION USE: /-/V ;-7 PO r f7 [J G' G k <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) i <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. UP <br /> C <br /> V <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 C <br /> Z! z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). _ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TOm 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- Q <br /> INGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 <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. I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 'N ��0 <br /> ISSUED. 1 <br /> i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. zC <br /> CONDITIONS OF PERMIT: /7 <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. 05t/ <br /> ri/JrC& 9'/9 <br /> ;a -0 nr- O O -0 <br /> 6. a 3 m c <br /> ow U33 <br /> 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 10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m g c <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- O <br /> sue a permit. I further accept all liability which may be a result of the Gou ty of IX nett relying on this Information I am m <br /> providing in this application. I agree to permit county officials charge tad igistering county ordinances or other m <br /> authorized person to have access to the above described premises ata ttme for the putptise of inspection. n E E <br /> CD <br /> SIGN HERE <br /> U 1776 <br /> (signs o o or r tractor) (date) p i <br /> ZONING ADMINISTRATOR BURNETT s ' / � � . . . . w <br /> Cn <br /> ZONING <br /> N N N N UI 01 <br /> N N O N N O O <br /> TO NSHIP PERMITS MAY BEREQUIRED 00000 0 0 <br />