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V-)'] C1" <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator it- o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> w <br /> CL <br /> • ✓ o '7 al <br /> OWNER � <br /> E t TELEPHONE -2 S7—3-32,-2-- <br /> p <br /> l Ci i <br /> II� /7!!5N e- (� W <br /> HOME ADDRESS ;Z 1>O 6 �n l SQP✓I ci / h � Dh a H ✓ <br /> S ✓. / <br /> -y SIS e <br /> EMERGENCY/FIRE NUMBER c2gc,� 6 ROAD NAMEWAtse eri nS /rve lae c — <br /> // <br /> LEGAL DESCRIPTION(see tax receipt) ,4o fi C;z, <br /> v <br /> o) <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE�DDITION Cr <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: V <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) $ <br /> n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m ' ;b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn n <br /> NORTH(N). W ° <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, � c <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. °N i <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 6 <br /> 61 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q ° 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c �) <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. R <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY U I <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. x - eu rpy� 0�0 rn <br /> � 3 CL <br /> 6. 3 ywoNO3 <br /> Z : (A 0 <br /> 7. ' ` ' y m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; 3 2 E E ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of 0 E ' C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m : 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 m <br /> providing in this applic tion. I agree to per un o cials charged with administering county ordinances or other m <br /> authorized person t e acce to e b des becr premises at any reasonable time for-the.purpose of Inspection. -n <br /> m : <br /> e : <br /> cD -3 <br /> SIGN HERE !' <br /> 61,97 <br /> (sl ature f owner o (dab ) 1 i ? i i <br /> LIN, 0a 3 WT QliZONING ADMINISTRATOR Q � 4 <br /> h <br /> . <br /> ` j h H40 <br /> N NNNN(r� <br /> Vt fi1O�°�OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 0 <br />