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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -D O Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> y O <br /> N <br /> /�.,���,,,�j'� <br /> OWNER Aklb*S w//[L7]I�IYC9�,1/� TELEPHONE <br /> w_ <br /> MAILINGADDRESS -7, �l of, � O <br /> l <br /> PROPERTY ADDRESS Dly4IV r. 04 <br /> {�}� �l�r <br /> LEGAL DESCRIPTION(see tax receipt) 1,a���Z �a �.(N � � <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE, ADDITION Ll / c 0 <br /> TYPE OF PERMIT(S): 12 t I/,q <br /> Cr <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION ❑ /,,� •7v��J a <br /> STRUCTURE/ADDITIONQSE: f ° ��I)�� D jnC� gp'xi? / Mr GOT o <br /> Ho a/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> w <br /> BUILDING CONTRACTOR: At <br /> m <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> m <br /> _ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. -n Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> M <br /> NORTH(N). C <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 -9 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO v 1 0 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N V <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. Zcoo <br /> a <br /> F I� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. n ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z �C/ <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. v <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5• This structure to be used as private residential <br /> 6 �F garage/storage only. Not to be used for human CD: m m > m a F m <br /> habitation. �9, c y y o <br /> 7. Z n m o l 0 a <br /> O A M <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my : <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w n ifl C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C o remit <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 1 amm, <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> i o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. (D Cn <br /> = <br /> m o : <br /> �fd �0 <br /> SIGN HERE �� //—TJX m� w <br /> lure of owner or building tractoor) —�— (datera <br /> ZONING ADMINISTRATOR I \ <br /> gyp; ed L� C� �Qb` o?� — <br /> N N N O O <br /> WNSHIP PERMITS MAY BE REQUIRED o cn o 0 <br /> (k,Itp THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v� <br />