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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 Z <br /> APPLICATION FOR LAND USE PERMITS , <br /> r <br /> {{ ,(I, et,K &/z- Sob- viva o ° <br /> OWNER �t�ae J s/ /Lens TELEPHONE <br /> 9 O <br /> vm <br /> $ 1 3/ o rwOQL nAC0. QMAILINGADDRESS o <br /> PROPERTYADDRESS 'Zyn sAWC Lake PJ <br /> LEGAL DESCRIPTION(see tax receipt) <br /> T' <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> TYPE OF PERMIT(S): ❑ 0 <br /> v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> L. <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> Dnslk o� ° <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) p m <br /> ,n n <br /> m Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m !? <br /> NORTH(N). <br /> O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m \. .a <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. - I 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 GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 t <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,a o <br /> o :E <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN m g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT w <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 -� . d <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER G <br /> SETBACIK AREA. <br /> 5. ND improvernerrl �san�1� y, bu �ld��q�,�1�.�ncrowch an camnl�n lo} III„ry <br /> J' IW A m (>r DODO M <br /> 6. m x 3 n m x a m A <br /> OQ A C y N O_ 3 <br /> 7. Z C N N O -D= <br /> O N <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bem <br /> at of my d+: A <br /> 'O'c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m a <br /> all information contained in this application(including any accompanying schedule)and 1 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 am m : o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ,o M <br /> authorized person to have access to the above dqscribed premises at any reasonable time for the purpose of inspection. `o M <br /> r a : <br /> m : D ; <br /> n : <br /> SIGN HERE � 9-28-05 <br /> (sig ture of owrWr or building contractor) (date) o <br /> Flail ZONING ADMINISTRATOR ( r 1 u q an e� <br /> f (A ER Vi 6i N <br /> \>o MW W O <br /> TOWNSHIP PERMITS MAY BE REQUIRED C o a o a v o <br /> THIS PERMIT SHALL EXP ONE YEAR FRO <br /> M DAT OF SSU N <br /> �rmz� leJ` r (MI te +o rheas <br />