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Burnett County 7410 Co.Rd. K, No. 102, Siren,W► 54872 Office of Zoning Administrator -0 C) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> N <br /> OWNER Y vi 11 Uy n TELEPHONE <br /> MAILING ADDRESS I -I I I rG i /�r ► n ."�t �Lt „�1 I� O <br /> 'o)+ <br /> PROPERTY ADDRESS ` J 'L ` r n <br /> i. � fJ LJl <br /> LEGAL DESCRIPTION(see tax receipt) '` 2l) <br /> m <br /> A <br /> ARAGE/ACCESSORY STRUCTURE ADDITION ❑ � <br /> TYPE OF PERMIT(S): S4$ >T 3("P I< Q <br /> FILLING/ RADING LO CAMPING UNIT El SUBDIVISION ❑ l] a <br /> "y ` -o1 .2 X 201lt�oldL < <br /> STRUCTURE/ADDITIONUSE: )trilc- /(olbik—) !� < <br /> c <br /> (Home/Cabin; Com rcial Business; Bedroom; Deck; etc.) m <br /> !! _ m <br /> BUILDING CONTRACTOR: 5E L-F d' <br /> 1 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 't <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) oI[ O C J <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �^. <br /> NORTH(N). <br /> CA 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO In 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. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. G <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 7 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ) <br /> CONDITIONS OF PERMIT: T <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. C� I - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. }� V7 C) <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 /> mm u > � a ° m <br /> 6. m x 3 n m F a m ."0 <br /> R o m C y ." o D 3 <br /> T. Z C y A O 7 0 1 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i ! A <br /> �n c , C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of vl+ <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other ,o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. `D <br /> r a : <br /> m D <br /> m <br /> SIGN HERE a✓ �^ �I 0 ea E n i <br /> (signaturet of owor bu'diing contractor) (date) <br /> owner <br /> ZONING ADMINISTRATOR ui ai F to/1 L stn I <br /> O N N W W N O <br /> o O UI O UI N N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR F O DATE OF ISSUAN E <br /> � (m7o <br /> 4- ie- f rte; i -o 'Cep sa sarah KL,✓n <br />