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blt cfyycp <br /> office of Zoning Administrator -V G) Z <br /> WI 54872 (D 0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren 3 <- <br /> APPLICATION FOR LAND USE PERMITS <br /> CD <br /> TELEPHONE <br /> OWNER <br /> 0 <br /> HOME ADDRESS <br /> ROAD NAME <br /> EMERGENCY/FIRE NUMBER 50—V—rL-C— V') <br /> RIK )O <br /> LEGAL DESCRIPTION(see tax receipt) q1— /67 L T";z 9 <br /> 0 <br /> TURE LJ ADDITION PRIVY LJ 0,= <br /> DWELLING/BUILDING 0 GARAGEIACCESSORY STRUC Cr <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING El CAMPING UNIT 0 SU13DIVISION <br /> 0 <br /> STRUCTURE/ADDITION USE:-'�(Aon =C��x I Ct <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) W <br /> 2. <br /> BUILDING CONTRACTOR:---Y <br /> PAPER. ANY INCOMPLETE OR <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X I I SHEET OF 0 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ja <br /> 0 CD <br /> DIRECTIONS F )R PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) -n CL <br /> ,n Z <br /> 0 <br /> 0 <br /> M <br /> OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a 9 <br /> 11. ALL REQUIRED DIMENSIONS )AND ALL NEW BUILDINGS(NB)AND INDICATE 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB 0 <br /> W 3 <br /> NORTH(N). 5,(B)BUILDING(S)TO M <br /> OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINE! 1)OF <br /> 3. SHOW DIMENSIONS IN FEET UREMENT TO THE ORDINARY HIGH WATER MARK(OHWN Z <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEAS <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DIF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> SEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IZ3 <br /> 5. INDICATE IF A WALKOUT BA ER,BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINE <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CON D IT I ON aD-E-P-E-RIMIT: C> <br /> DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> I <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> 3, <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. -0 0 r.- <br /> 0 -a <br /> g rn <br /> 5. x <br /> C: <br /> 6. Z : COD <br /> 0 <br /> =Cn nn <br /> 7. including any acco anying schedule) has been examined by me and to the best of my 3 C'T 10 <br /> for the detail and accuracy Of @ v S <br /> knowledge and belief it is true c rrect and complete. I acknowledge that I am responsible 12 a x <br /> further declare that I recognize . . . M <br /> all information contained in th' lication(including any accompanying schedule)and I i i 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> i <br /> am <br /> all liability which may be a result of the County of Burnett relying on this information I Q . . . <br /> sue a permit. I further accept county officials charged with administering county ordinances or other !D I <br /> providing in this application. I agree to permit i <br /> the purpose of inspection. -n <br /> authorized merson to have access to the above described premises at any reasonable time for . . . <br /> 6 : <br /> 0 <br /> (date) <br /> �SIGN HERE : <br /> (sign ur of owner or build tractor) <br /> 40 <br /> 4b�69'A���� <br /> ZONING ADMINISTRATOR <br /> CD C�C>0 0 0 M <br /> 0 oy <br /> WNSHIP PERMITS MAY BE REQUIRED <br />