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-.._ -. <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS _I <br /> N <br /> _ z n <br /> OWNER Jj TELEPHONE <br /> f <br /> MAILINGADDRESS � <br /> PROPERTYADDRESS etc�./ ' -•l o S4 <br /> 1L 2) �^+ 3� 11�G C+r SD^ 00 <br /> LEGALD�RIP�16N(ee az receipt) � t� �G )• I`{0� d- L�l �d`I �"���/""`�� � `N° <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ TN-fu tj c <br /> n c <br /> TYPE OF PERMIT(S): t'\•")a- )Tw• a <br /> FILLING/GRADI G ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �. <br /> STRUCTURE/ADDITION USE: <br /> ome/Cabin; Commercial Business; Bedroom; Deck; etc.) d <br /> BUILDING CONTRACTOR: r AVLU1� m <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 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n <br /> T <br /> ?t O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m9.1 <br /> p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE CO <br /> NORTH(N). om _ o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ( J�o <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. (� <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. Q N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS ?, o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. V4 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PERMIT: W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT OW Q <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 ll <br /> PERMITTED. V <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS. ETC.. ALLOWED WITHIN THF RFOtIIRFn WATFR <br /> SETBACK AREA. This structure to be used as private residential <br /> s. garage/storage only. Not to be used for human M m d d > o a O m <br /> habitation. x 3 R m x a <br /> 6. c: <br /> C7 a( <br /> . C7a( Z c m o N 3 <br /> 7. D i E i m <br /> = N [ »: O <br /> 1 declare that this application (including any accompanying scneeuie) nas oeen examinee Dy me ano to the nest of my 2 , N C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Doi <br /> m m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- J [ G1 <br /> sue a permit. I further accept all llabilit which may be a result of the County of Burnett relying on this Information I am !.\ <br /> m o <br /> providing in this application. 1 afire to rmit county officials charged with administering county ordinances or other V' <br /> authorized person to a access t the a v described premises at any reasonable time for the purpose of inspection. <br /> ni <br /> SIGN HERE date <br /> o ' <br /> (sig atu of owner or building contractor) (date) <br /> ZONING ADMINISTRATO <br /> fA 6i fA 63� N <br /> G OfNT O(WJNNO <br /> TOWNSHIP PERMITS MAY BE REQUIRED V <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF J§SUANCE <br /> Verm�k 4 lt-kkr ma'Altd -ro se1'ry, Va d LL-S <br />