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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v C z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y o <br /> N <br /> OWNER j p�< y l L S tV TELEPHONE CO 12. 6 O 4 - P 1-1-7`-1 _ <br /> m <br /> MAILINGADDRESS F0 BU Y\ 1-7Z`D I SST- PAvl-- MN 5�1 i 7 � O <br /> r � <br /> PROPERTY ADDRESS <6 C) ty O,o,K.. L-AK,F <br /> U2-`1J HIZ� C'-S ` <br /> Ko.� SZO <br /> LEGAL DESCRIPTION(see tax receipt) <br /> fs0V GSM V 1 2-1 0 <br /> DWELLING/BUILDING ❑ GARAGEJACCESSORY STRUCTURE ® ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> 5. 11 <br /> STRUCTURE/ADDITION USE: L7 C'�` e �� I T. <br /> ]Q✓ <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) y <br /> BUILDING CONTRACTOR: 5> L <br /> m <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. T <br /> XI n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m a <br /> -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. j d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(8)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(OF),AND ALL DISTANCES TO �- C <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> S. 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 CQNTRACTOR, ETC.,THE PLANS I 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. i> 0 1 <br /> f <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VE I I v S <br /> NEEDED. A <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. NPR 2G 3 o J <br /> CONDITIONS OF PERMIT: J <br /> NI 1 Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OFBUR <br /> RM, EETT COUNTY U11, <br /> ISSUANCE. L�LONING V i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY r <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> Ar DODl7 'O <br /> mm m 0 m a f m <br /> 8 3 8 0 00.o <br /> CD <br /> a m Cw o g <br /> 7. Z Nm0 'Io -4 <br /> 2!' ."D <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myc C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ; m 0 : to <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m n N- <br /> O; my <br /> that this information I am providing will be relied upon b the County of Burnett Wisconsin in determining whether to is- <br /> sue <br /> P Y tY 9 <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information 1 am m ; <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> to <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o � <br /> T o : <br /> SIGN HERE <br /> CL ' <br /> (si a re o er or building contractor) (date) G <br /> ZONING ADMINISTRATOR <br /> fA N fA*19 10% <br /> (/ Q V1 O Vt V•O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />