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Burnett County 7410 Co.Rd. K,No.102,Siren,W154872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> ^' r <br /> ID <br /> m o <br /> w <br /> 1 c <br /> OWNER I�i 14kf„ {.• ��FiK�,� TELEPHONE '1L3'434�4 35 w <br /> MAILING ADDRESS t o s r l"l sf L fJ u A 6 Aoo 4/i boat v f <br /> � � m <br /> PROPERTY ADDRESS 21266 lArm l So,j RoAo 1/0,S TIVI <br /> LEGAL DESCRIPTION(see tax receipt) PCl J— al-4D-149 (O�L Ub -1) <br /> DWELLING/BUILDING 2 GARAGE/ACCESSORY STRUCTURE 9 ADDITION ❑ <br /> o <br /> TYPE OF PERMIT(S): or <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a T� <br /> 46L) 4696- I tEw 6p2�u1'► y <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) N <br /> m <br /> BUILDING CONTRACTOR: �t'C'G <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. (� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N r� o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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 GI;' 1* ' SH <br /> LIED. N O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUIL T E PLANS � 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. < Ste• o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V IFICA3b2 MAYBE D N y o <br /> NEEDED. �Up JV( I' Z � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. RIV1 .� ��� p <br /> CONDITIONS OF PERMIT: CO 11\ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT IT�/NUS U�, r <br /> ISSUANCE. S C <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 C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITFj(Cl THE REQUIRED TER �y <br /> SETBACK AREA. <br /> 6. oo meo- Aduijadto maw I �Ioocp�/�"F"jj m u m d <br /> 6. /)1 A79 s!�oa,/� �c Fr o q.�j v/l�eGf �J`� Se�bAilj m m o c f m <br /> O All S-t�t— 0041ali 61-11C <br /> My N y j 7 <br /> 7. w o i o <br /> o T,e m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP (• 9 Y ) Y Y E � <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of E m n C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I 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 a '• m <br /> providing in this pplication. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized persqrn Ito have accqsq to the above described premises at any reasonable time for the purpose of Inspection. m ' o <br /> CD <br /> SIGN HERE to p1 <br /> i <br /> ($i Btu r of o ner or bu)d09 <br /> contractor) (date) Q <br /> l`�': f �% <br /> ZONING ADMINISTRATO I E <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF <br />