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Burnett County 7410 Co.Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNER.Il9t r-t .� /V i N C.. M I's,ku-.l S TELEPI-ZONE q-13- SD`! <br /> o s <br /> w_ <br /> MAILINGADDRESS �� �'�E ^ mCAA-eA 4Y / tX 4o'i el:3 m <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ N 0 p <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADINGo' <br /> //❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> STRUCTURE/ADDITION USE: 4/rtj a-r�ylL ) 0 <br /> ` (Hom binLCom / tial Business; Bedroom; Deck; etc.)/ /�J Co <br /> BUILDING CONTRACTOR: <br /> 6331 X <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 635 X 11 SHEET OF PAPER. ANY INCOMPLETE OR w <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. &7 SI k, 6k (20- TO t� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n a <br /> ?I O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n y v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). <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)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ( 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. `L <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER, ro' o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z t <br /> CONDITIONS OF PERMIT: oI I 00 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. - O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. be <br /> fef><OlftL� <br /> 5. Not) -CUnf i,-mj/iS1ri.LcJzA�L WIM,h /00'of lake Seibaek fhuSf <br /> 6. .• m m � ��af m <br /> w 3o.m n- a = M <br /> N C y y O S �+ <br /> 7. Z <br /> O T� <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m D <br /> PP , 9 Y ) Y Y C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I em responsible for the detail and accuracy of m n : F»E <br /> all Information contained in this application(including any accompanying schedule)and I further declare that 1 recognize [ m ! o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to <br /> 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 i G): <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ro E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE ..,dL4 e, 4y�V, 5131 XA� j <br /> FL : <br /> (signet re of 6w or or building contractor) y (date) n <br /> ZONING ADMINISTRATORII� IUI(JIf I <br /> N N N O O <br /> N O N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE 01,1E YEAR FROM DATE OF ISSUANCE <br /> k4t84-+Perm;-_ 1 iCkd UP 10/ro105- <br />