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Burnett County 7410 Co. Rd. K, No. 102, siren,WI 54872 Office of Zoning Administr for M C) Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> y, O <br /> 41 <br /> OWNER <br /> S' oGlit Pt <br /> TELEPHONE VCP3 _ N, s <br /> MAILINGADDRE / Ca <br /> 0 <br /> m <br /> PROPERTYADDRESS a gg S�C'b A o <br /> I _ <br /> LEGAL DESCRIPTION see tax receipt) o — <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE p ADDITION Cn o <br /> TYPE OF PERMIT(S): c � <br /> FILLING/GRADING//❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: Oda'-41-0- - Shqa 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck, etc.) Q) <br /> m <br /> BUILDING CONTRACTOR: P <br /> d <br /> v O <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Yz X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> 0 m C) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p W <br /> n n <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. nn <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 V <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO t <br /> BUILDINGS, ROADS, LAKE, LOT LINES. (� <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 P N NS `� ° op <br /> MUST BE SIGNED AND DATED BY THE OWNER. o I <br /> O 0 r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHE4 o � <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ) <br /> CONDITIONS OF PERMIT: <br /> 1 DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. W 7 <br /> 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY J / <br /> PERMITTED. vV <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS. ETC..ALLOWED WITHIN THE REQUIRED WATER •, <br /> SETBACK AREA. This structure f0 be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> 6. habitation. CD C Q) Q) 0 ° a o m <br /> CD <br /> p m C N <br /> 7. Z C N O 1 <br /> P mE m <br /> o-'' in: A <br /> I declare that this application (incluaing any accompanying scneoule) nas peen exammea oy me ana to the best o my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accura y of `9 m C <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m C m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether t is- J (-D ' in t7 <br /> � : <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information am 0 o <br /> providing in this application. I agree to permit county officials charged with administe i er <br /> authorized person to have access to the above described premises at any reasonab e 1 0 A r o <br /> n <br /> SIGN HERE I - -G CD a <br /> ig ature ner or building contractor) DEC d / j <br /> ZONING ADMINISTRATOR J <br /> BURNETI• COUNTY C o N o w w N o <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM ATE OF I�SSUAN E <br /> I-+elr ' rv� I- mal'ie�fo fn(� 1 U/San l ll-T 5 <br />