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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 . <br /> N O0 <br /> N <br /> C <br /> �g d <br /> OWNER " �A� n„�N TEHONE 3 LJq -41 <br /> MAILINGADDRESSL�O <br /> m <br /> ) , ( <br /> PROPERTYADDRESS S �O �lZ --7C)C) <br /> a <br /> LEGAL DESCRIPTION(see tax receipt) aG N2Q C--Y`d - 9+--ADDITION <br /> i� I <br /> DWELLING/BUILDING !❑ GARAGE/ACCESSORY STRUCTURE L'1 ADDITION ❑ C <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ (1 <br /> STRUCTURE/ADDITIONUSE: STp( ��\= rU )(go o c� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) W <br /> v <br /> BUILDING CONTRACTOR: m <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3' (d <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T . <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). <br /> _ n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO Iyrl 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. a <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 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> O Z3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o (� <br /> NEEDED. <br /> w <br /> THIS PERMIT IS SUBJECT TO ALL CONDff IONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: p <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. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK %REA. H. <br /> 5. <br /> 'U co 0r- DODO -0 <br /> 6. This structure to be used as private residential ; C d 0) S CD a f m <br /> > >c3am �- » � .� <br /> garage/storage only. Not to be used for human i. o y y y > > 3 <br /> 7. N '^ m o : <o <br /> habitation. o T- : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m _ cn ' i i O <br /> PP ( 9 Y ) Y Y G) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 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- m to <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 d o <br /> providing in this application. 1 agree to permit county officials charged with adminis r ' <br /> authorized person to have access tot above described premises at any reasons I I t e f' c a <br /> -n <br /> i <br /> OT D i <br /> SIGN HERE m Es _a i <br /> Iq gna a of o buil ing contractor) ( t `• o <br /> ZONING ADMINISTRATO <br /> SEP 1 X085 <br /> (A<n 4W N <br /> BURNETT COUNTY p , N U WWNO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ON,NG 0Ln00 w N o <br /> THIS PERMIT SHA L EXPIRE �NE Y AR FROM DATE OF ISSUANCE - I505-Pocrn4 *- � WU " -- :-� 0 ope <br />