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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> -I / C <br /> OWNER ht ..k ��sfih UC/7u k1 TELEPHONE (OSI- (98;2-J r+�72 ^p <br /> m <br /> // '' 7 t� m <br /> MAILINGADDRESS ��233 WA. E1Nanr L►Y.l:� >�cuen Mh,. �y /.2.Z _ O <br /> _ r � <br /> PROPERTYADDRESS j�JJ � I l //tj 0/� UAL o <br /> 379n TY.('rnDOtU (�tr, V6v4r�F VAL�, <br /> v <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ o <br /> TYPE OF PERMIT(S): Q <br /> c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> m <br /> STRUCTURE/ADDITION USE: 6261 -3�, 0 p <br /> (H�e/C bin; Commercial Busin/tle�s/ Bedroo'yrt/y{r)Deck; etc.) 2. <br /> m S <br /> BUILDINGCONTRACTOR: h �Y/V/r I-3 m <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN BY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO 3 O <br /> O y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. () m )0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m Jy 3 <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. ") C o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO CR <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ry <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 � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN = CTI <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o (-Itz�i� I <br /> CONDITIONS OF PERMIT: (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J J (j� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (-0 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (C*� <br /> PERMITTED. �" 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER 1 <br /> SETBACK AREA. <br /> - I wyW5 _ --f �� 04 -��S 0Qnabe— <br /> This <br /> structure to be used as private residential <br /> � mF a � m <br /> 6. n <br /> a A <br /> garage/storage only. Not to be used for human zg y7. o a <br /> habitation. o ; ; z <br /> I declare that this application (including any accompanying schedule has been examined by me and to the best of m _ ^� ' O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m u` <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize cc C m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m M <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 app ion. I a ee to permit county officials charged with administering oral dinances,o_c-other °' `D <br /> authorized person t e ac the above described premises at any reasonable hhh� r s ilp m a <br /> I T <br /> D <br /> SIGN HERE <br /> (signnaa7lu-r��off wner or/bu �l6 �oOJilding contractor) j (d e [ o [ <br /> ZONING ADMINISTRATOR V r I J t�nln' � L ,T ` ? <br /> TOWNSHIP PERMITS MAY BE REQUIRED'"P 1 O COUNT' <br /> ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FR M D#.TE F ISSUANC <br /> UP,/(n-, 4- <br /> $cLrlc>�2�5 /l-�-DS <br />