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Burnett County 7410 Co. Rd.K, No. 102,Siren,W154872 Office of Zoning Administrator _U o 0 <br /> APPLICATION FOR LAND USE APEnRMITS <br /> N O» <br /> CD <br /> OWNER /% 5� TELEPHONE <br /> MAILING ADDRESS 4'/U ��r��� /v� C/IL �� � Sj��c/ 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) Lpr /f'��✓�(� ���/( 'Q L (� j cn <br /> Q <br /> DWELLING/BUILDING ARAG CCESSORY STRUCTURE ADDITION ❑ to <br /> TYPE OF PERMIT(S): C <br /> ❑ CAMPING UNIT ❑ c <br /> FILLINGIGRADING ❑ SUBDIVISION <br /> N <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial usiness; Bedroom; Deck;etc.) <br /> deli - V��jto1n � ��'JG <br /> BUILDING CONTRACTOR: ` � <br /> d <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. <br /> 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n ii p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S <br /> NORTH(N). y o <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 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. ry <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: A� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT f 1 <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. �O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER t <br /> SETBACK AREA. y✓ <br /> 5. / <br /> m w m n O a v M <br /> This structure to be used as private residential r > 0 a f m <br /> 6. garage/storage only. Not to be used for human 6. � c y ^ o 3 <br /> 7. habitation. o y m 0 <br /> 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 of m n v. c <br /> v <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize OQ M m o mQ <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> G7 : <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 �: d <br /> providing in this application I gree to permit cou officials charged with administerin coun o . ances or other <br /> authorized person to have a to the above de r' d premises at any u e of inspection. -nm in <br /> } M' m m <br /> SIGN HERE i AUQ� fn <br /> (sign ur_o wner or building contractor) 1 a <br /> l , AUG 2 9 2003 a <br /> ZONING ADMINISTRATOR (� <br /> fA fA fA 6A � N <br /> BURNETT COUNTY ,33031 6361 o o 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRMNING <br /> l,rlil(d lz Lvt&s y- 3 --6-3 <br />