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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS . P <br /> OWNER �"H/✓ A10/jL)S.7-^b—, TELEPHONE 71�, $ ' Soto/ <br /> �YJ O <br /> d <br /> MAILING ADDRESS ato 9S 3 kle4 rS,=� knp_ � / . O <br /> 'lf <br /> PROPERTYADDRESS Gt �;9Aj?ZR <br /> � � P <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) U <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE KADDITION ❑ o <br /> TYPE OF PERMIT(S): o <br /> FILLING/GRADING ❑ CAMPINGUNIT ❑ SUBDIVISION ❑ n �' <br /> STRUCTURE/ADDITION USE: /"epi L— L. <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) rn <br /> T� <br /> BUILDING CONTRACTOR: R o" P-90F4:�:^T 3. <br /> Z <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8rh X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) O m <br /> -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. TZ <br /> 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C O <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF), AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. O <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 1. <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 o W <br /> m <br /> F <br /> NOTE: NG/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 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 S <br /> ISSUANCE. r^ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. vl_7I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. a and > a O 9 <br /> m 3nm xL1dM <br /> 0 C y y O <br /> 7. Z N iD O rG <br /> P a <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- m G <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 application. I agree to permit county officials charged with administering county ordinances or other '• 'm <br /> authorized person to have access to the above described premises at any reasonable time for to <br /> the purpose of Inspection. , <br /> m : : <br /> m <br /> om i o : <br /> SIGN HERE �� Gf/1 / <br /> LLL m : <br /> (signature of owns building contractor) (date) <br /> i n <br /> ZONING ADMINISTRATOR <br /> `l E 0 moo <br /> oo <br /> N N ry N 0 0 <br /> p <br /> TOWNSHIP PERMITS MAY BE REQUIRED rn o <br />_ THI �(/Y)ai �dA/ . XtcV MGfiARR_ROK6hT DfrSUANC�oZ�o�� <br />