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Burnett County 7410 Co.Rd.K, No.102,Siren,W154872 Office of Zoning Administrator c o <br /> V <br /> APPLICATION FOR LAND USE PERMITS 3, <br /> * r <br /> N � <br /> / M <br /> OWNER r •//r r e.SL/G �+-IL'tiS !7Q✓r�s ..•� TELI`PHON�(OS1✓ 121, -6607 a <br /> HOME ADDRESS Y'r� t f3�'�-C it4a9- IaJc3 »?n, STUD � <br /> r <br /> EMERGENCY/FIRE NUMBER y S ROAD NAME L R%OI n cS7 I <br /> LEGAL DESCRIPTION(see tax receipt) t 1 UG/L ` �� t� 5 k S fa t S 1 (n <br /> DWELLING/BUILDING Iff GARAGE/ACCESSORY STRUCTURE ❑ ADDITION El PRIVY ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> ,p 5. <br /> STRUCTURE/ADDITION USE: rJ YYZ P� Q1 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR:��S„y�� �4. <br /> v <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(ES)AND ALL NEW BUILDINGS(NB)AND INDICATE m .ar <br /> r n <br /> NORTH(N). <br /> 00 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING($)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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 r �l <br /> BUILDINGS,ROADS,LAKE,LOT LINES. t `2 <br /> 8. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C7 <br /> S. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. bi n <br /> 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. v 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 80 DAYS OF PERMIT <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. <br /> 5. <br /> 3n1o111T <br /> S. R e m <br /> —01 <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my c <br /> knowledge and belief It Is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of n E <br /> all Information contained In this application(including any accompanying schedule)and I further declare that I recognize eo SP <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to ls- i �, O <br /> : i <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information <br /> providing in this application. I agree to permit co my officials charged with administering county ordinances or other n ? i <br /> authorized person to have access to the above ribed promises at any reasonable time for the purpose of inspection. 'n E <br /> o : <br /> e <br /> SIGN HERE <br /> stun of owner ullding contractor) (date) <br /> ADMINISTRATOR 40 40 <br /> NMtn N Lao <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 <br />