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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 3 <br /> r <br /> OWNER �9-`� 9L -�_. TELEPHONE y�8' ! �.3 J 0 �` J <br /> m <br /> O <br /> MAILINGADDRESS �1G / �Q/(/!�[� C9/�G�G�/U/QIj'• ��pON e_/,( ��/ �. <br /> I o <br /> PROPERTY ADDRESS CIS <br /> O � <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) d <br /> � 2_ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE El ADDITION R <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONDec7❑ C/r 2 (� <br /> STRUCTURE/ADDITION USE: 0 r <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m (h <br /> SEI <br /> BUILDING CONTRACTOR: <br /> � 1 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> W m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> -n <br /> ?t a Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C v �. O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 03 <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(OF),AND ALL DISTANCES TO ` <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 0_ <br /> MUST BE SIGNED AND DATED BY THE OWNER. �'0 0 3 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o O <br /> CONDITIONS OF PERMIT: _ <br /> I <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. a <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 /> 0mm > oaoM <br /> v = m Cy .`^ o 3 <br /> 7. o <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP ( 9 Y ) Y Y �2 ; C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of , n a <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- (nO <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 C�% d 0 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m n <br /> 0 <br /> D 0 : <br /> SIGN HERE <br /> (si ature wner or building contractor) (date) VU[ o <br /> ZONING ADMINISTRATOR V `' 'Flo rr� <br /> bi fA EA fA� N <br /> O N N W W N O <br /> ONO (lfn (Jr0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF iSSUANC <br /> 94� 5--.30-Db <br />