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11 11�k <br /> Pol <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> N W <br /> CD <br /> C <br /> OWNER Af ti TELEPHONE 1(p�,=X51 3313 0 <br /> OD <br /> MAILING ADDRESS 136NA 5r <br /> PROPERTY ADDRESSLCW <br /> o <br /> LEGAL DESCRIPTION(see tax receipt) L941U-1 ")A"C4n (Qr►P( QayibAN 'KA 54830 Qm <br /> 1 � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ CO 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING CAMPING UNIT rV SU DIVISION ElCL <br /> STRUCTURE/ADDITION USE: c2-Q 0 <br /> (1-14e/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: , <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81k X 11 SHEET OF PAPER. ANY INCOMPLETE OR m �` <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m0 a - M r <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 <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. P <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. V\ (�_ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. SCJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS C OM <br /> MUST BE SIGNED AND DATED BY THE OWNER. o O <br /> I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. �. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: Tj <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (� Q <br /> ISSUANCE. (J1�. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ) r <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ay <br /> SETBACK AREA. <br /> 5. <br /> CD wr�mcD. F T <br /> 6. m3 a F a m w <br /> '13 m y y O j r. <br /> 7. N O O 0 <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m O <br /> PP ( 9 Y ) Y Y � ; ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofa a N <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize n mm c 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- v 1 <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 E ro i <br /> Providing in t is application. I agree to permit county officials charged with administering county ordinances or other o <br /> m : rn <br /> authorized pe on to have access to the above described premises at any reasonable time for the purpose of inspection. CD o, <br /> �y fn W <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) i n <br /> ZONING ADMINISTRATOR nImt'Jl ni Cttn y9`• <br /> 3 z fNn ril ro i OO <br /> " TOWNSHIP PERMITS MAY BE REQUIRED <br /> 1 �)N THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />