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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> CD <br /> m o <br /> OWNER l9fn� \S>0 .3 TELEPHONE (c / V 4 7 d 17 2 0 <br /> MAILINGADDRESS 1 `? I VE` S CpG t Gf N� FO <br /> rr m <br /> � o C <br /> PROPERTY ADDRESS S y 1 5 f O (�\ <br /> LEGAL DESCRIPTION(see tax receipt) Qh <br /> 1 ky <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ C o <br /> TYPE OF PERMIT(S): FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ QrIVU 'O� 6 / rt� on 1\,/ aQ <br /> 4- <br /> STRUCTURFADDITION USE: G t% A On I q-n 7:/-- b un d0w J .� <br /> (Hom Cabin; Comm rcial Business; Bedroom; Deck; etc.) ( <br /> 2. <br /> BUILDING CONTRACTOR: K Q em z;`. <br /> m <br /> m r _ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE 04 T 3 � xl <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p `JjJ <br /> N O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> M Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m ti 30 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(Nei)AND INDICATE C \ n <br /> NORTH(N). y o <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 PHWM)OF ` Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. v <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTIANCES TO G <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLEDW 1�)O N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'o o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BEiDONE WHEN .�'», ° vV <br /> NEEDED. <br /> (] <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. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY \\\VVV Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS. ETC-- ALI.nWFn WITHIN THE RFOHIRFn WATPI� 1 <br /> s. SETBACK AREA. This structure to be used as private residential <br /> garage/storage only. Not to be used for human m m d iu > o a v m <br /> 6. habitation. M 3 a a <br /> -o omcyyo53 <br /> 7. N w N`1G _ �1 <br /> m -nm <br /> I declare that this application (including an accompanyingscneouie nas peen exammea o me ano [ the nest of m _ m ' d' O <br /> pP ( 9 Y 1 Y yCT <br /> C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m �_ • o, <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m c m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determini g whether to is <br /> C <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. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpo a of inspection. m a <br /> -n <br /> SIGN HECI-2-,S�)� .s. r_ � �" 9. -O 5 cn . a <br /> (Sicinature of owner or buildingcontractor) (date) (� o <br /> ZONING ADMINISTRATOR i rn I W / _ /'• '• <br /> Q. 6'in in in: 69 69i <br /> t10N0 (W/i <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEARFR M DATE F IS U CE <br /> Tffnr+- + IeW-rolallIv -i ans4'ucf76r`1 tb -off-v <br />