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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> rn O <br /> OWNER/&k& <br /> � , TELEPHONE <br /> MAILINGADDRESS ZI(G( LCwI�C� C.if�CS �0"N `tiJ�C D!¢�/' JS�� O <br /> o m <br /> PROPERTY ADDRESSS/VC g, <br /> LEGAL DESCRIPTION(see tax receipt) ��-}- �,5{y� L I ( �V� O m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ rn o <br /> TYPE OF PERMIT(S): I Q _ <br /> FILLING//GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> STRUCTURE/ADDITION USE: &-%PG,4 f- o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: ni�/{/ 1 (ir/i 1410,� Z-,4r- v C/) <br /> m <br /> 3 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> 93 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y _ o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(8)BUILDING(S)TO In 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. 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, O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N CN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 f J <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <br /> 0 �) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ^» o <br /> NEEDED. �V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> n Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. V <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. f n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 <br /> PERMITTED. I� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS. ETC_ ALI OWFD WITHIN THF RFOUIRFn WATER p� <br /> 6 SETBACK AREA. This structure to be used as private residential Y <br /> garage/storage only. Not to be used for human > o a o -0 <br /> 6. habitation. CD° ' 3 a a <br /> o m c N " o 5 3 <br /> Z cc: 0o <br /> 7. o <br /> _ U) : m <br /> I declare that this application (including an accompanyingscneaule nas been examined b me and to the best of m p <br /> PP ( 9 Y 1 Y Y E G) <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of w' �_ c <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize CD c - mm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to �is- D 0 in: <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 o : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. `D 'a <br /> m <br /> m D <br /> CD o. : <br /> SIGN HERE. L el. <br /> (s' na um of own r or building contractor) (date) 1 , <br /> ZONING ADMINISTRATOR U <br /> ' in E» <br /> 3 r(Zn (J N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROMpATE OF ISSUANC S��f-aS <br /> �2 rrri�k lG4'fPl Plf 2�l rc�o by OrI /anal Bkl rr5 <br />