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Burnett County 7410 Co.Rd. K,No. 1102, siren,WI 54872 Office of Zoning Administrator - ° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> C <br /> N <br /> 6 <br /> OWNER�I�f' /I ._v_ i TELEPHONE��/S � <br /> MAILING ADDRESS <br /> keg <br /> MA- <br /> I A y� I o <br /> PROPERTYADDRESS /�/ I <br /> LEGAL DESCRIPTION(see tax receipt) <br /> m <br /> pp�1 A <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE A1.1 ADDITION ❑ <br /> TYPE OF PERMIT(S): ' n <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> ((❑ S. <br /> STRUCTURE/ADDITION USE: Sf©f_(/�-� '( 1�� SL <br /> 0 <br /> (' (Home/ in; Commeraa(Puslness; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: ��"1 <br /> U.v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 9 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn — o <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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 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. 1° o <br /> o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN = ° <br /> NEEDED. B <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t <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 /> 5. <br /> This structure to be used as private residential M w d M $ M g f m <br /> 3 R m Om a <br /> 6. garage/storage only. Not to be used for human , s N y 3 <br /> v � m C N o <br /> habitation. Z " ° ' -a <br /> o m i A <br /> 7. i m <br /> - 2 n: A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my , : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? o. » A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ; 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. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am ' m [ o <br /> providing in this application. I agree to permit county officials c I rin county ordinances or other <br /> authorized person to have access the above describ premix 'dn t I e u ose of inspection. <br /> m Dd <br /> SIGN HERE <br /> (signature f owner o bu'4i !contra • (date) <br /> S ��n i MAY a 2006 In <br /> ZONING ADMINISTRATOR I ' ' <br /> BURNETT COUNTY 8 ������N <br /> O <br /> TOWNSHIP PERMITS MAY BE RE G <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM Of ISSUANCE <br />