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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator vC) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N � <br /> OWNER TELEI'FiONE P715- U <br /> MAILINGADDRESS 35"36 W• �OuSrtrryt ST6 ru Lt1Al.�°L—, WZ— 5'{� <br /> PROPERTYADDRESS O oZ 6 <br /> t-oT3 d—c.P" ✓6 P3/3b Cl/V 6-ov tors <br /> LEGAL DESCRIPTION(seetaxreceipt) 3010 - E/ So2�TgO/ .ej5W /55/0 <br /> (� m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (J�u�BO /�, 0 <br /> U1 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ElCAMPING UNIT X SUBDIVISIO�j ❑ <br /> a <br /> STRTURE/ADDITION USE: o <br /> IX <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: <br /> o, <br /> m <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. -n 3 <br /> O <br /> .Z1 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> CD <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T n Z <br /> O A <br /> Rt <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) 0 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO UilA\/ <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 � <br /> MUST BE SIGNED AND DATED BY THE OWNER. 3 <br /> v -1Z <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. oZ I <br /> CONDITIONS OF PERMIT: C' <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. (n C� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ^1 <br /> PERMITTED. UVJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. 0 NC% CAM OM f&A IOWMEZ cl LY <br /> 6. ✓n�X 7�mis 4r�lr 6 mo-r�r S mw nr n m oc nn <br /> m3 a <br /> 7. <br /> T K m <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my j' A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> -1J : <br /> a Information contained in this application(Including any accompanying schedule)and 1 further declare that I recognize nr ; o : 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 am v <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> /� T O : <br /> SIGN HERE 2GtA bCZ.t_.4. t z-ct-/40. J J' OJ <br /> a : <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR /n l/Qn ' © : <br /> fA di 69 fA1 N <br /> NU• N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ()• ON (TOO <br />