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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> 7(n3- 757 338- <br /> 33- No" <br /> OVNER TELONEIaw7&3-Z30-1LV -Coll <br /> v <br /> m <br /> MAILINGADDRESS 13W� Iffic(lSd Sr NW _ MQ� 10M �� r <br /> �4t o <br /> PROPERTYADDRESS Zq,41 (OrCA_ [-k)V(er, (QyM _ Y1 rV IAL 5qb3c) <br /> LEGAL DESCRIPTION(see tax receipt) zViCaUCInYY, LIU _ l <br /> l <br /> DWELLING/BUILDING 13J GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ to <br /> TYPE OF PERMIT(S): <br /> FILLING GRADING ElCAMPING UNIT SUBDIVISION ❑ C1< <br /> STRUCTURE/ADDITION USE: _ - ) <br /> (Home/Cabin; Contnercial Business;Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 (u <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y 0 <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 01 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. 1 O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. lJ N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS f� <br /> MUST BE SIGNED AND DATED BY THE OWNER. ! n <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° Q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o y / <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT J A Q <br /> ISSUANCE. <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. W <br /> 5. <br /> G) m n M a E m <br /> 6. $ 3 m Xam <br /> v <br /> � N y N O <br /> 7. y O o -{ <br /> = m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my _ y p <br /> Qc C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of mn v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E o my <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 /> P P ty Y tY Y 9 OP <br /> providing in this appikcation. I agree to permit county officials charged with ad finances o other o <br /> authorized person to NbVe access to the above described premises at any reason c i n. -nm o <br /> m <br /> SIGN HERE - <br /> n � n . <br /> (si n ure of owner Ior building contractor) - JUN [ v (dateL. " <br /> ZONING ADMINISTRATOR <br /> 1A d)W 0 N <br /> BURNETT COUNTY N N N O O <br /> TOWNSHIP PERMITS MAY BE REc�UIRED ZONING <br /> Rrrnl ++ (e' +ky- o-�( led --/D ?ol / ES Sen 6— a9-05 <br />