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Burnett County 7410 Co. Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator "a o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N » <br /> N <br /> C <br /> C I� �f IJL/�W/) /✓t T(/CZ - CD <br /> OWNER <br /> OWNERJI;TOM TELEPHONE 7� 5�� So- JG 7/i <br /> o <br /> MAILING ADDRESS 6 o� c✓A G S p&PbUry 1It SZ133d � <br /> a <br /> -Q� <br /> PROPERTY ADDRESS <br /> 1 \ a <br /> LEGAL DESCRIPTION(see tax receipt) p'7 — 0 3 2 ' Z "Y f — '('o —l Z -O O 2 1400 c <br /> �y » <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Lp, ADDITION ❑ (n ° <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING �❑ CAMPING UNII/T ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITIONUSE: �/Lr7{� G `d /�.(pvL � �-1AJ�' j rn ' <br /> b� )(- (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) C <br /> BUILDING CONTRACTOR: ^A % 2- r n i FL <br /> C <br /> CD <br /> I f <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) a 'Z <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C �j o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO L <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ot <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. <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIAY BE DONE WHEN <br /> NEEDED. / 5 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. f � I ^ o <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> ISSUANCE.MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF WRMIIpT�� `�2003 // R) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOCfRELII <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ZoZ COOn /V <br /> ,� CN <br /> PERM <br /> 4. NO STI UCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATE19 0 <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential d iu> a a f m <br /> 6. " 3 R 2 Ow a <br /> garage/storage only. Not to be used for human <br /> CD c y o :3habitation. Z y ° ' ° M <br /> P r <br /> �. ;, 70 <br /> _� Art <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of v n v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize pG; m E : O M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 <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 remises at any reasonable time for the purpose of inspection. m o <br /> D DG <br /> SIGN HERE 2 -U a <br /> gg ure o owner or [ding contractor) (date) c^�I <br /> Y <br /> ZONING AD NISTRATOR <br /> mc0 NulP � O O <br /> 0 O OI Ln O O <br /> TOWNSHIP PERMITS MAY BE REQUIREI{3 U3 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE O <br />