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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 /> ^' r <br /> y O n , <br /> C>�) <br /> OWNER LLw�qy(ter' TELEPHONE I Cj�✓S(p-51 Q>gj <br /> 111 p 0 <br /> MAILING ADDRESS 5U Qj�C� U�CjO/J VJ I S-4t oI(C> 1 <br /> 0 <br /> PROPERTY ADDRESSLI.•QZCP ' Vo(�Qp��(� APo6 tR,`I W t �» <br /> LOT'S Ch VA Q 1 {�p 2- / \ <br /> LEGAL DESCRIPTION(see tax receipt) 1N Goy/ Le'[S ��m(, PRT LOTS (i L r s� 'J9 P(is (yj "T> ) CD <br /> �( 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE IQ ADDITION ❑ <br /> TYPE OF PERMIT(S): <br /> a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> ���ez ay x a� y <br /> STRUCTURE/ADDITIONOSE: -T�A o <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: J�L� 2 <br /> d <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 v <br /> O m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) m a <br /> ?I o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m I z <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 W <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. f I <br /> v <br /> ;rZ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF10 � p, <br /> J <br /> � <br /> NEEDED. 0. -1l <br /> Q-) <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. I APR 5 o I <br /> CONDITIONS OF PERMIT: l <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PEOURNE77ISSUANCE. G, <br /> OUN <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE.ZONING <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <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 :0 0 r a 0 a 0 a <br /> garage/storage only. Not to be used for human CD W w n 1D a m m <br /> 6. habitation. z y �o N <br /> 7. In <br /> -cn : E In <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my 17, <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a 2 N <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> rn <br /> authorized person toliavjejac ss to the above described premises at any reasonable time for the purpose of inspection. m o <br /> 1 CD Im :II m <br /> SIGN HERECL <br /> (signature of owner or building contractor) 1 (date) <br /> ZONING ADMINISTRATOR �) <br /> 69 69 d! N <br /> ("O" 00 <br /> '5 f TOWNSHIP PERMITS MAY BE REQUIRED <br /> /L THISPERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE U� <br />