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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _U0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> i�T o <br /> m <br /> ,t,I <br /> OWNERk,49L N L ieC t eS TELEPHONE <br /> iVej_r 4,,weiA o.P 2 o <br /> 4r\/ �// <br /> MAILINGADDRESS 7 �////�/,4,C q CPQ Al 449 64 A6_ 2 y <br /> PROPERTY ADDRESS 2 �`�O(7 �� �/Y�t(�/ AIX- <br /> 0#a�,2- va i3-o3iZ e Grp <br /> LEGAL DESCRIPTION(see tax receipt) ���� m C, <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 11CAMMP'ING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: P d y 0 <br /> // <br /> Home/Cabin; Commercial Business, Bedroom; Deck; etc.) co <br /> nn m <br /> BUILDING CONTRACTOR: <br /> /tit.Nt v <br /> C4 <br /> m <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. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C) <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). (n " <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 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 1 C <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 2 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. o r <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. + <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o W <br /> CONDITIONS OF PERMIT: LN <br /> (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Ll Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY } <br /> PERMITTED. g <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE � �II�[Ij��/v�A,T <br /> SETBACK AREA. ?// i <br /> NYE <br /> 5. C_pr..o -Jlj ,f j 7 , /'Oh t�ctJGt °"'Yjrl U`P`�L �L /'10 L-d��l�� ao O r D O D t7 'V <br /> �0` APR 2 ' 2005 � 01 � 0f !EM <br /> 6. This structure to be used as private residential ,� 3 n D " a a z <br /> o y' O N O <br /> �. <br /> garage/storage only. Not to be used for human BURNETT COUNTY o 5 : T _ <br /> habitation. - m <br /> I declare that this application Inc�uu,,, (mined b me st of m • � 0 <br /> PP 1 aa..j Y Y � c -4 : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofa » <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m my <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. 1 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 administecin Couwty©r¢MattQes_orother <br /> .QQ� v <br /> authorized perso to h acces o the above described premises at any reasonablp,timeifbrthe a 'o nspec ' m a <br /> T <br /> SIGN HERE a <br /> '(Si tur of owner o uil 'ng contractor) (d j i o ' <br /> APR 1 ' *5 <br /> ZONING ADMINISTRATOR <br /> /in i en N) <br /> QgaSy bf ail(,'k�c plkee{�,'��) BURNETT COUNTY O N 0 W W N O <br /> o � 0 � � 0 <br /> � <br /> 24(I L4 S 13-0-1- r�'f/QO TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> '70q(V) -1 oo P -4PdT SH LL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> (Y at WL6Jk 12-1 f +0 Karl At le-leets <br />