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Office of Zoning Administrator o 0 <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,W154872 3 <br /> APPLICATION FOR LAND USE PERMITS N o <br /> TELEPHONE 7715 7 L,3 7 C,!57 <br /> 0 <br /> OWNER <br /> rn or.» w) 54C)1 <br /> MAILING ADDRESS )R W(Q � � S �/Z SET NEW I ( ra 0 <br /> PROPERTY ADDRESS ti• [: �r`�' <br /> NE 1/4 SEL Z3 60V L17r � <br /> LEGAL DESCRIPTION(see tax receipt) (�Q (Ej N! Tblh1N �� SCL�1T (3U2wETT CD . 1 0 <br /> ('1) <br /> o <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE L-1ADDITION ❑ <br /> TYPE OF PERMIT(S): / a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ E <br /> STRUCTUREIADDITIONOSE: <br /> N U S7'' I R ASE To <br /> � (HomelC in; Commercial Business;Bedroom;Deck;etc.) <br /> BUILDING CONTRACTOR: sFz <br /> y <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> 3 . <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. � <br /> O a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) _-,nv-, Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (^ O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m[� o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m r <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF W o <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 Q <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLEDVj <br /> . <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. o <br /> �0 o <br /> =. <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION M ��WH �� <br /> NEEDED. `Yt ®� L) <br /> z <br /> o C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. I, t <br /> CONDITIONS OF PERMIT: M4Y D �oo� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> U n <br /> ISSUANCE. ) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINR/,/F <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY \ 0 C <br /> PERMITTED. A�l,,/� <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATTEP/ 6 �,y • ' P <br /> SETBACK AREA. <br /> 5. m WW0MnEm <br /> 0 Sam Fam ;U <br /> � <br /> Cu N : 3 <br /> o <br /> m <br /> 7. - � : O <br /> (7 c C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my n c <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy e m m o : v <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <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. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am . <br /> m <br /> : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other =ro <br /> authorized person to ve access to the above des ibed premises at any reasonable m nable time for the purpose of inspection. m <br /> a ; <br /> SIGN HERE (date) <br /> (sign turqofer or building contrac r <br /> 1.9 <br /> ZONING ADMINISTRATOR d' r" N <br /> cN„ ocNi+ cNi+oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />