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Burnett County 7410 Co.Rd. K, No. 102,Siren,W154872 Office of Zoning Administrator m o Z <br /> APPLICATION FOR LAND USE PERMITS <br /> r N O \ <br /> C <br /> ^ C. <br /> OWNER ��h FAV TELEPHONE L{(R 09 0 3 5 3 0 <br /> � <br /> O <br /> MAILINGADDRESS a Ro �(,�ISS h icp"`/ 6he f t Ake �yl Sit Y 7 ( CD <br /> CD <br /> ( o <br /> PROPERTYADDRESS 5 e <br /> Cn <br /> ' <br /> a � - 3� - <br /> LEGAL DESCRIPTION(see tax receipt) sE- sem m <br /> (n o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIO a <br /> v <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRA ING ❑ CAMPING UNIT ❑ SUPDIVISION ❑ () <br /> STRUCTURE/ADDITIONUSE: � U4 <br /> ome/Cabin;Commercial Business;Bedroom Deck;etc.) o' <br /> / m <br /> LO <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a z <br /> n v A <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> LO <br /> NORTH(N). m 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO <br /> m <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. <br /> N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR,ETC.,THE PLANS . o <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN '. <br /> 9) <br /> NEEDED. ' <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (ll) <br /> ISSUANCE. v" <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 THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. W m 0 m f m <br /> 3am0 2. .;0 <br /> m <br /> 6. N > > 3 <br /> Z nCD 7 =1 <br /> 7. = Cn : p <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Q� C <br /> m= o m <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize t7 <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue apermit. I further accept all liability which may be a result of the County of Burnett relying on this Information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> CD <br /> Ott! L/mon Co -Ar DQ a <br /> SIGN HERE (date) <br /> (signatur of owner or building contractor) <br /> t V i <br /> ZONING ADMINISTRATOR �// <br /> (1.N (69T'En <br /> N OO <br /> n�Vj CTO (T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />