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Z <br /> R1 <br /> N <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o°� o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O V V <br /> N C <br /> C 1.1 <br /> N <br /> OWNER C TELEPHONE -1 LD U5 2 a <br /> 1 ' l J _O <br /> \M4.L�` O <br /> MAILING AD � <br /> DRESS I L CAta�� �{,lL--i 1 l S <br /> PROPERTYADDRESSrr�� t' � Q <br /> Saort or\ 3 5 Tower 3q P�c�c�.G ly W \\ a <br /> LEGAL DESCRIPTION(see tax receipt) Z0+--1L �, Sfn I Jt ( � 7 �1 <br /> GIGf �• N�5u1. J ((�� � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ sLuS� yJ W O �.. <br /> TYPE OF PERMIT(S): J <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <' <br /> STRUCTURE/ADDITION USE: lr3 d�[� 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) v <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 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> ;o N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O `m <br /> n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m �} <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). (n �r' 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO m T o <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS ° <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> o � <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° I <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ' <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAININ(;WAI I!; FTC At I OWFD WITHIN THF RFQIIIRFn WATER <br /> 5. SETBACK AREA. This structure to be used as private residential <br /> garage/storage only. Not to be used for human X m d r >o a o m <br /> s. habitation. � � 3 a � ; a A <br /> 0 m C y fn 0 <br /> 7. Z C N O <br /> C N <br /> U) m <br /> I declare that this application (including an accompanyingscnedu,e nas peen exammea o me ano to ine best of m d' 0 <br /> PP (� 9 Y I Y Y G) � C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d <br /> aE <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 6) cn <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 o her <br /> authorized person to qave accepp to the above described premises at any reasons r a <br /> m <br /> D <br /> _a . <br /> CD <br /> SIGN HERE ` n <br /> (signature of wner or building contractor) at ) o <br /> J <br /> ZONING ADMINISTRATOR �) AUG 1 0 20 f <br /> ��ffl EA <br /> URNETT COUNTY Q <br /> TOWNSHIP PERMITS MAYBE REQUIRED B �z�NING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM PATE OF ISSUA <br /> -Pec(Y-) i�-4I 1���( (YY.i M-d 4v LOrri e fi-W S / <br />