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Burnett County 7410 Co.Rd. K, No. 102,Siren,W154872 Off.ice of <br /> APPLICATION FOR LAND USE PERMITS Hing Administrator o o <br /> ^' r <br /> y O <br /> OWNER1 p / n/ <br /> j/✓A �Flyd RY TELEPHONE c C� <br /> MAILING ADDRESSSdN�?r5f T m O <br /> 5Y03 <br /> PROPERTY ADDRESSCD <br /> '27,�� Sr/NRrs� (!/ yt/e�sj�2 J a <br /> 1.�>✓ <br /> LEGAL DESCRIPTION(see tax receipt) Csm V 1'7 P 19.- <br /> ��/t _ / <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE k4 CD <br /> ADDITION ❑ a <br /> TYPE OF PERMIT(S): y 0 <br /> FILLING/GRADING ❑ CAMP1yG U T ❑ SUBDIVISION ❑ Q <br /> /o( a <br /> STRUCTURE/ADDITION USE: 5C ' oogeI4 00';L <br /> n {( <br /> (Home/Cabin, Commercial Business; Bedroom; Deck; etc.) 0 <br /> BUILDING CONTRACTOR: � <br /> p � <br /> / g p G _ <br /> InvS1r m <br /> iu <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 <br /> O <br /> DIRECTIONS FOR PLOI PLAN DRAWING (AERIAL OR TOP VIEW) m G <br /> On CL <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T 0 <br /> Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ° <br /> WETLAND AREAS. <br /> 4. SHOW THEE OCA AM OR <br /> OF THE WELL(W),SEPTICRIVER AND MEASUREMENTOTANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS, LAKE, LOT LINES. 5)� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> � o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI <br /> NEEDED. WHEN 0 <br /> tel, � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOWc <br /> EONDITION OF P RMI . (` a 0 <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PF��1 I 'D I' <br /> ISSUANCE. A'c <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELII�!ve�CQ I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �C/t/jNC UA <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> CV <br /> SETBACK AREA. <br /> 5. <br /> 6. <br /> n r 0 > 0a <br /> 7. <br /> 3w 00 :E m <br /> m � a m x a � � <br /> Z y m <br /> 1 declare that this application (including any accompanying schedule)has been examined by me and to the best of my <br /> all information contained in this application(including a0 T ' M <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of �; m <br /> that this information I am providing will be relied upon m <br /> ny accompanying schedule)and I further declare that I recognize ti m <br /> by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. I further accept all liability which may be <br /> m ` <br /> a result of the County of Burnett relying on this information 1 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other w <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m : W: <br /> SIGN HERE CD <br /> m o <br /> (signature of owner or building contractor) <br /> (date) a <br /> ZONING ADMINISTRATOR , <br /> fA <br /> Cn FA ro <br /> TOWNSHIP PERMITS MAYBE REQUIRED N N 0 0 <br /> cn o �cn o 0 <br /> a l,U-n THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />