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Burnett County 7410 Co. Rd. K,No.102, Siren,W154872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> 0 <br /> m � <br /> OWNER � � � AZ 4 TELEPHONE BGG Y96 6 0 0 - <br /> w V- <br /> m <br /> MAILING ADDRESS r7 , ( Fr em s f eA 9A--P a-4 U4� —434Y.30 <br /> Jr m <br /> I <br /> PROPERTY ADDRESS �'t' ^. -bow L A' c -r ys pI K 16 to <br /> \\ 1 i <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING Kr GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ C/) <br /> 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION El RE <br /> STRUCTURE/ADDITION USE: Ch6 iJ' <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> � r <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> „ H G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o. <br /> z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Mn w jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> El <br /> @� <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO F <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N0 Co . <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. <br /> kco o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o W <br /> NEEDED. ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. U o <br /> CONDITIONS OF PERMIT: �J/ <br /> 1 <br /> ISSUANCE. <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS Of ERMIT�I` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SlfitELINE. 2 3 W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICPERM <br /> L <br /> 4. NO STI UCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WJTHIN THE REQUIF'i;4 L U/V� G <br /> SETBACK AREA. ( '— r/�/ <br /> 5 s6t -7- 6?,4-0L/- C . aM/7.1 - <br /> $ 0)= 08CL <br /> a m Cy m o T+ <br /> 7. a : a <br /> o <br /> 0 '� : m <br /> declare that this application (including an accompanyingschedule has been examined b me and to the best of my <br /> ^� <br /> PP ( 9 Y ) Y -2 : ; i C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of piu n virD <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeCD <br /> N E m o me <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- b <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 m <br /> providing in this application. 1 agree to permit unty officials charged with administering county ordinances or other m <br /> authorize n to have access tot bov m m:escribed premises at any reasonable time for the purpose of inspection. - o': <br /> ID <br /> SIGN HERE )3 <br /> (signs owner or build) contractor) (date) ` o. <br /> i <br /> ZONING ADMINISTRATOR hi h/ C i E i i i <br /> W JGL►� p1 O (T Ol O O <br /> n �Q( TOWNSHIP PERMITS MAY BE REQUIRED <br /> �� THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />