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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator T o 0 <br /> APPLICATIO14 FOR LAND USE PERMITS :j. <br /> r <br /> n O <br /> ` N <br /> OWNER /�` �S ` TELEPHONE 7�f'C�(f - a3b n <br /> a3lo/ PJI'alafiA G . 020 ,(nAj SS113 o <br /> MAILINGADDRESS <br /> PROPERTYADDRESS t--tIe I <br /> 1 co <br /> LEGAL DESCRIPTION(see tax receipt) OS� ✓ 4 , <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ti 3 <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADIN ❑ C MPINGUNIT) ❑ UBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: t/`� C 0 <br /> om abin, Co mercial Business; Bedroom, Deck;etc.) of <br /> BUILDING CONTRACTOR: 41vio <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE QRf' T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. QNFJ O 4-1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AE RIAL OR TOP VIEW) b (/ 4� A _ ' O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. See " �3✓f� "N U r n o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL XISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y 3 <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) EASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASURE MENT TO WETLAND AREAS. I o <br /> 4. SHOW THE LOCATION OF THE WELL(W) SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO W <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS I ILANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED B AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE 01 VNER. o f <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS I MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 91 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: rn <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDT REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND V GETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY OEIV <br /> 4. NO STRE <br /> STRUCTURES, INCLUDING RETAINING A'TWALLS, ETC.,ALLOWED WITHIN THE REQUIRED" EM- ED ' <br /> SETBACK AREA. <br /> 5. AUG 20 2002 <br /> CD d° n F m <br /> 6 .$ 3 Lm xa D ;a <br /> D H 4 3 <br /> ,_ BURNETT COUN Z N <br /> o <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and o e es of my C <br /> knowledge and belief it is true,correct and co plete. I acknowledge that 1 am responsible for the detail and accuracy of m en <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that 1 recognize m 0 : 0 <br /> that this information I am providing will be rel ed upon by the County of Burnett Wisconsin in determining whether to is- CD� <br /> sue a permit. I further accept all liability whit I may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to perrr it county officials charged with administering county ordinances or other m <br /> authorized person to have access to the abovf described premises at any reasonable time for the purpose of inspection. ID o <br /> ID m ; <br /> 6 <br /> SIGN HERE <br /> n : <br /> (sign re o e or it ' g contractor) (date) <br /> ZONING ADMINISTRATOR <br /> fA fA EA 49 N <br /> N M N N O O <br /> ( 000100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />