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Z— <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> �(� c '�J <br /> OWNER KQt�t-t Qr©t<Q PecTELEPHONE ���- Y T/-c3 91 el C-) a <br /> m �1_ <br /> V` <br /> MAILING ADDRESS <br /> PROPERTYADDRES _y <br /> Parr N 5 ie r 5 E /iii O — �? <br /> LEGAL DESCRIPTION(see t ipt) pp P/4rc e_ w C <br /> /1'IA/>y fD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ( o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADI , ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n �� <br /> STRUCTURE/ADDITIONUSE: t .clfJ�>tJ( <br /> Home/Cabin;Commercial Business;Bedroom; Deck;etc.) E <br /> d <br /> BUILDING CONTRACTOR: ('A'7 et,1 <br /> 42 <br /> m <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. T — <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> n o A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �^ <br /> NORTH(N). C 0 <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 O 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 d <br /> BUILDINGS, ROADS, LAKE,LOT LINES. N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 8 IF MUST BE SEPATE GNED AND DATED PLANS ARE MITTED THE BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS ? o <br /> NOTE: NBUILDINEEDED. <br /> G/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT71��7 o <br /> HEN 6 QW� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o f <br /> CONDITIONS OF PERMIT: <br /> L <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMj2003 n, <br /> ISSUANCE. i ivj <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ) cot] <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY -ONIr !n li <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. V+ <br /> 5. &&silo T y—//7-0 3 6- <br /> 6. m W 0, 0Ma5M <br /> 3 o.20 0 a s 111 <br /> 'O N C- <br /> 7. Z N O O(O <br /> T M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my -r»' ' p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m c C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I 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 recognize <br /> is- a 17 <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 obi <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other d <br /> authorized person to have access tot ove de ibed premises at any reasonable time for the purpose of inspection. co i <br /> T [ t <br /> O <br /> CID <br /> CD <br /> SIGN HERE 3— <br /> n : <br /> signature o owner or b ' g co or) / (date) <br /> ZONING ADMINISTRATOR o <br /> illi N (INNO <br /> U O( N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />