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Burnett County 7410 Go.Rd.K,No. 102,Siren,W154872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> N <br /> CL <br /> OWNER O~ IC , TELEPHONE TS'63J- S13t y O <br /> J. C� O� <br /> MAILING ADDRESS - 6/ 0p 2h Ayr U H fVyj 57�� f <br /> CD <br /> r CD <br /> PROPERTY AD RESS SQ n(- \ e <br /> S151'7-3"1z1W 3,36aere5 <br /> )G GLI,r Lo7-1,?A S <br /> LEGAL DESCRIPTION(see tax receipt400('r6 f t)1-0 GkS///P A SEL y /JLC i-K1NR 11)�hf�rett�io►, p�ELNe C�pvrLe�/ an LaCt fi�c..N oN E[Na� g <br /> DWELLING/BUILDING 11GARAGE/ACCES ORY STRUCTURE X ADDITION 06fJv7,4ot/ 1r0 rn <br /> TYPE OF PERMIT(S): Po a <br /> FILLING/GRADING ElCAMPING UNIT��SUBDIVISIONEl <br /> I/t�Q (/�-I/ / LA. <br /> STRUCTURE/ADDITION USE: <br /> r4- 31 o-V y <br /> 11 <br /> me/Ca Commercial Busine ;Bedroom; eck;etc.) C _ (� <br /> 0 1 <br /> BUILDING CONTRACTOR: A ro <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81AX 11 SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> -A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 °a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. p , <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. m' F <br /> o Q ', <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA NE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. / v o I <br /> CONDITIONS OF PERMIT: <br /> L <br /> pq��' � � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF 'rV ` � J� <br /> ISSUANCE. \. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIq CO / 1 <br /> 3 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY N//VG LN� � � O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER t <br /> SETBACK AREA. <br /> a. / This structure to be used as private residential <br /> garage/storage only. Not to be used for humanr D O a o m <br /> N d 0 N o. f m <br /> 6. ' yam <br /> habitation. ;~ H " o 3 <br /> Z <br /> ° : <br /> 7. o <br /> M <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m d, <br /> 5-D <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m $ : bi my <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person tqAave access to the i1bove d scri d premises at any reasonable time for the purpose of inspection. ID o <br /> SIGN HERE n <br /> ( gnat ner or building c cr) (date) <br /> ZONING ADMINISTRATOR -771 <br /> 0 0 W <br /> N <br /> N N O O <br /> lJy Cl'I cn (T O O <br /> TO NSHIP PERMITS MAY BE REQUIRED V <br />