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Burnett County 7410 Co. Rd. K, No. 102, siren,WI 54872 Office of Zoning Administrator -nC) Z <br /> APPLICATION FOR LAND USE PERMITS 3 o ° <br /> r <br /> n 0 <br /> OWNERbel c�,CJ-� i L 11; /' TELEPHONE ` n 1Z <br /> f TTT 111 '7�S 3-aa-� o <br /> MAILINGADDRESS <br /> lll20 /Y�12(r� �v c: �P /�C , sgs3f7 <br /> r � <br /> PROPERTYADDRESS I o <br /> LEGAL DESCRIPTION(see tax receipt) S <br /> t m t� <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1-1ADDITION El C/) a <br /> � <br /> FILLING/GRADING ❑ CAMPING UNIT X SUBDIVISION ❑ o: <br /> STRUCTURE/ADDITION USE: ( r&rn0 f 1[) ur); k /i V&(j J — Ql.,. T CPO L05- <br /> 0 \I <br /> Home/Cabin; CommercialBusiness, Bedroom; Deck; etc.) � <br /> fel <br /> m <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In � <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) p <br /> c <br /> In a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m t A <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 W ( 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. \ <br /> 5. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> ILI o <br /> D 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � o <br /> NEEDED. N <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. (� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 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 /> 6. m co0O) m 0 Cnf m <br /> N C y N O <br /> 7. Z C in ry O O t0 4 <br /> o m � m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ` = � O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of \: m U : C <br /> all information contained in this application (including any accompanying schedule)and 1 further declare that I recognize mm <br /> W : m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is <br /> m ' <br /> �) � : <br /> sue a permit. I further accept all liability which may be a result of the County of Bur el ' f m r � � : o� 0 o <br /> providing in this application. I agree to permit county officials charged with adi r T <br /> authorized person to have access to the above described premises at any reason i r r s f' i <br /> \ : o , <br /> SIGN HERE a <br /> (si natuurye-of owner or building contractor) -APR r„ `i�fioll/ p <br /> ZONING ADMINISTRATOR )/ i / E70019Lq 7 <br /> ��EA. EA fR�N <br /> ZONING C) " " N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPI E ONE Y AR FROM DAT OF ISSUANC <br /> P�'c u P /, LX we4-1 A// -alo-ate WN-4-PT <br />