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Buenett County 7410 Co. Rd.K, No. 102 Siren,WI 54872 Office of Zoning Administrator 0 o o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O l 1 <br /> C <br /> _ E Mon anc� a <br /> OWNER LI A.) <br /> MAILING ADDRESS <br /> PROPERTYADDRESS l< Ci{/!� ✓�L <br /> W 1•c1 i —qa CSM K3 PA/ .-3- <br /> LEGAL DESCRIPTION(see tax receipt) ) M <br /> DWELLING/BUILDING - GARAGElACCESSORY STRUCTURE ❑ ADDITION ❑ (� <br /> TYPE OF PERMIT(S): a <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVIS ON ❑ N. <br /> STRUCTURE/ADDITION USE: ./Y 1 0 <br /> Ll -r 0 <br /> ( ome/Cabin;Commercial Business;Bedroom;Deck;etc.) U <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m0 9t <br /> o A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �v <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 t o <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS 11 LANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> S. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0, <br /> 0-1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'a° <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS WUST BE STAKED SO AN ONSITE VERIFICATI6 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �] JUL 3 f 200 <br /> CONDITIONS OF PERMIT: / Z (c,�, <br /> BURNE� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITNOUN <br /> ISSUANCE. ZONING ^moi <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY CV�1 <br /> PERMITTED. �j�f� <br /> 4. NO STRUCTURES,INCLUDING RETAININ WALLS, ETC.,ALLOWED WITHIN THE <br /> REQUIRED WATER / ^,` 1 <br /> SETBACK AREA,. n !J <br /> 5. �G � <br /> t/�7 <br /> �}- r/ 3 n ° app/i ram � _ A <br /> o <br /> 7. L� �� / o ren m <br /> I declare that this application ( luding any accompanying schedule) has been examined by me and to the best of my G) O <br /> knowledge and belief it is true, orrect and complete. I acknowledge that I am responsible for the detail and accuracy of n N <br /> all information contained in this application Including any accompanying schedule)and I further declare that I recognize o : mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- � <br /> sue a permit. I further accept all liability whi h may be a result of the County of Burnett relying on this information I am m <br /> providing in this appl' ation. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to ave access tot abo a described prem'ses at any reasonable time for the purpose of inspection. fD o <br /> CD <br /> CD <br /> SIGN HERE <br /> (s n ure of o r r ullding con ctor) (date) <br /> ZONING MI TRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> �'�Choifc- <br />