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Burnett Cott'Olty 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator ' o <br /> ' APPLICATION FOR LAND USE PERMITS 3. - Zr <br /> tO <br /> N <br /> OWNER <br /> S L IJ A v ; / ` TELEPHONECD <br /> w <br /> MAILING ADDRESS 7530 N„ AC sl. G nil u m v O <br /> p r <br /> Y = <br /> o <br /> PROPERTYADDRESS �Q 1 I` CI, F0 r <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ � t/> ok <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON ATL AST AN SYS X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNEd. p <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 6 m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALIJ EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). co 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m � o <br /> CENTERLINE OF ROAD,(C)BUILDING(SI 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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. 01 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS(PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N w <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v n <br /> NOTE: BUILDING/STRUCTURE LOCATIONS(MUST BE STAKED SO AN ONSITE VE = ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J Au t � o (� <br /> CONDITIONS OF PERMIT: BV/ 6 f 6 2nnq 1) 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER1JIl7-' V1/C / <br /> ISSUANCE. Z_QNIG vN]y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIffVVEE. N <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 <br /> SETBACK AREA. <br /> 5. <br /> V'1C, M W r 0 C Da 0 M <br /> m <br /> 6. 3 n@ xa: m � <br /> a N C <br /> T <br /> �. Z in O <br /> O � m <br /> I declare that this application (including any l accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of V n <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize m O mm <br /> CD 0 <br /> that this information I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to is- <br /> G) :V <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. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the a o s ribed premises at any reasonable time for the purpose of inspection. CD o <br /> SIGN HERE 16 <br /> a : <br /> ( nature of own6r opr1luilding ontractor) (date) <br /> ZONING ADMINISTRATOR <br /> 6969 <br /> j-4 <br /> (� 16.9fA EAEA 0N�p N (1, NNOO <br /> � O (T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ir <br />