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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 /> 1no <br /> (n <br /> C <br /> rn _yy'.,I��I f fin\ / C <br /> OWNER 1 1 1errl l l mCINJt ��� TELEPHONEo <br /> n n O <br /> MAILING ADDRESS l �l� h jX jet 1 E <br /> o <br /> PROPERTY ADDRESS Oq fd-61 F <br /> �1 <br /> LEGAL DESCRIPTION(see tax receipt) -Fq f (4) .5 jk8 N� I1q See Z9 LI�3 7 ^Tt <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ADDITION ❑ (t., (n �'— <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UUNIIT ❑ SUBDIVISION ❑ f °STRUCTURE/ADDITION USE: 64ey!a oe, 4lY1p Y-40 < <br /> 0 <br /> (H e/Cala , Commercial Business; Bedroom; Deck; etc.) (n <br /> L ° <br /> BUILDING CONTRACTOR: SQ�1 � <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> (n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n d <br /> nT <br /> 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 0 c� <br /> NORTH(N). Cl) o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 A <br /> BUILDINGS, ROADS, LAKE, LOT LINES. �J W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N �1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 7 <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN f n <br /> NEEDED. w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: \\, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r C <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Cy <br /> PERMITTED. Ci <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> habitation. M C 8 12 D 12 R o lv <br /> 6. m � 3 =arn � �' � A <br /> Z C N N ° <br /> 7. ° N <br /> v : i i m <br /> I declare that this apphoauvi, t11N.1UU1119 ally dwvnlPdnynlg aweuulal 110� UCCA @Aa111111C4 uy me and to the best of my dv: L) <br /> ' : <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m' n �^ C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- :_( (n O <br /> �J D) 0 <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. 1 agree to permit county officials charged with administering county ordinances or other n m <br /> authorized p rson to have access to the above described premises at any reasonable time for the purpose of inspection. ° a <br /> T <br /> Di <br /> SIGN HERE U ' a <br /> gn ure of owner or building contractor) (date) 0 <br /> ZONING ADMINISTRATOR <br /> ��fA 6969 fA�N <br /> O N VI W W N O <br /> O N O D U U O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> V- lel--1tl-mriled it me(r�4 +--fuPsa' #?CbeLie11 I)-'P6-cc <br />