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ww.. <br /> Bufoett Gounjy 7410 Go. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator TI CD o 0 <br /> APPLICATIO14 FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> N <br /> \ G <br /> � t <br /> OWNER L TELEPHONE r�-� 1 610 <br /> d <br /> MAILINGADDRESS m O <br /> r � <br /> 0 <br /> PROPERTYADDRESS <br /> 2 5 o <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ Y In o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADIN C MPING UNIT ❑ SUBDIVISI N ❑ <br /> STRUCTURE/ADDITION USE: IS I Z <br /> om / bin; o mercial usiness; edro Deck;etc.) U <br /> r = <br /> BUILDING CONTRACTO . m <br /> i � 1 <br /> m <br /> CD <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. p N Vv <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL XISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y_ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S) AEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASURE MENT TO WETLAND AREAS. 9 <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 /> S. INDICATE IF A WALKOUT BASEMENT IS I ILANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED B AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o ? nI <br /> NOTE: BUILDING/STRUCTURE LOCATIONS UST BE STAKED SO AN ONSITE VERT J�7 /@q WHEN o �J <br /> NEEDED. �C ? lL C5 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: L Otic <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDT A REQUIREMENTS WITHIN 60 DAYS OF6T, C L 2. REMOVAL OR CUTTING OF TREES AND V GETATION IS RESTRICTED ALONG SHORELI /V co /3. NO GRADING OR SHORELAND ALTERATI NS ARE ALLOWED UNLESS SPECIFICALLYNIIVGN7 y <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAININGWALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. /� <br /> 5. r\ �� "� <br /> X nOi r rDi m a O 'D <br /> v <br /> 6. m 3amOx z <br /> 7. <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my p <br /> knowledge and belief it is true,correct and co plete. I acknowledge that I am responsible for the detail and accuracy of n N <br /> all information contained in this application(h icluding any accompanying schedule)and I further declare that I recognize m o mO <br /> that this information I am providing will be rel ed upon by the County of Burnett Wisconsin in determining whether to is- (D <br /> sue a permit. I further accept all liability whi h may be a result of the County of Burnett relying on this information I am d <br /> providing in this application. I adlTe to peR it county officials charged with administering county ordinances or other <br /> authorized pers have access t the ab v described pre ises at any reasonable time for the purpose of inspection. ° o <br /> to <br /> m m' <br /> SIGN H �� _ <br /> CL <br /> (sig f owner or building c ctor) (date) <br /> ZONING ADMINISTRATOR <br /> fA EA di� N <br /> NUI N O O <br /> M S O P 0 0 <br /> TOWNS IP PERMITS MAY BE REQUIRED <br />