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Burnstt County 7410 Co. Rd.K, No. 102,Siren,W154872 Office of Zoning Administrator _ o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> VN O <br /> C <br /> ,O 9 ,�1� G� N <br /> OWNER !°,'/ (/L /�/vim-f/f TELEPHONE �� 'y JAI7�,3 '2- <br /> 0 'V <br /> /J �/ (D O <br /> MAILING ADDRESS jy S r E!? (i✓OU C/ L I v CD <br /> r CD <br /> y� \ o <br /> PROPERTYADDRESS <br /> Lt f L c'SM r( i P la Se <br /> LEGAL DESCRIPTION(see tax receipt) S C r l 4,1,- 3 j w Y D ✓�' \ �' <br /> q <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Q} t <br /> TYPE OF PERMIT(S): 1a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ m <br /> o <br /> STRUCTURE/ADDITION USE: 9:19 �' JEN�� <br /> (Home/Cabin; Commercial Business;Bedroom;Deck,etc.) d <br /> BUILDING CONTRACTOR: Sati�,t � <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR ,n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> --r o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE y o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 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 <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,CONT+ J THE PLANS �. <br /> MUST BE SIGNED AND DATED BY THE OWNER. J 0 <br /> v <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT,ON MAY BED � <br /> NEEDED. MI� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. NN V �J o <br /> CONDITIONS OF PERMIT: BURVE7--COUNT, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ZONING <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> htyyL.0 <br /> 5. � <br /> jr� /q r DVN a n <br /> 6. G � c� Ft � D= <br /> yCoZv � <br /> 3 <br /> om <br /> 7. _J <br /> = rn : O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy ofo.2 M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o 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 <br /> ti <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T M o <br /> m m <br /> CL, <br /> SIGN HERE <br /> (signature of owner or bIrf <br /> (date) <br /> L <br /> / <br /> �l <br /> ZONING ADMINISTRAT IR 6,�,�,�,9 <br /> TOWNSHIP PE ITgT1i(AY BE REQUIRED �� ��- u <br />