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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator vc, Z <br /> APPLICATION FOR LAND USE PERMITS 3 o <br /> y O <br /> 0 <br /> y <br /> OWNER / b Q /u w�+�4�.. TELEPHONE <br /> y�� �obrn/�v��� m O <br /> MAILINGADDRESS f S/Z09 d C G� N1J _h� /�G <br /> PROPERTY ADDRESS y.2 <br /> LEGAL DESCRIPTION(see tax receipt) Cn 75- <br /> (D m <br /> c� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® S, rn o <br /> TYPE OF PERMIT(S): a, <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> /J � rn <br /> STRUCTURE/ADDITION USE: Ga-1,J;o o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: <br /> 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 /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> T n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n o A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S <br /> NORTH(N). c _ O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m O <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFA Z <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. <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. a <br /> O �Y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN .v'» o C/v <br /> NEEDED. n <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 \- <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 J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING <br /> ,,WALLS, ETC., ALLOWED WITHIN TH REQUIRED WATER <br /> 5. S�B`,///` ��"A. �p / tel"/'" 5d� rre <br /> ��"TT 1�f C6. "Sh� fr6G'�fl./ 0 w3raDODOm <br /> 'o CD m C <br /> p <br /> 7. Z c in O t0 <br /> m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m A <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m u c <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- f° <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 w o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasona6l i ctl n. o <br /> T <br /> ID <br /> SIGN HERE / n <br /> (si ure of own or building contractor) , (date) \': ': 0 <br /> ZONING ADMINISTRATOR SEP 4 2004 <br /> 13984 9-es-$x Ga en (1W , <br /> Sc. Par�TOWNSHIP PERMITS MAY BE REQUIRED ETT COUNTY Go o cn "n o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUjAjLNUUKN'G <br /> haI'led 40 <br />