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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 0 0 <br /> - r <br /> yCD <br /> O <br /> n C <br /> OWNER �N(� yf'��v�� �jN(� TELEPHONE f7X —/� /- 5-vX1^3V' /�7 n <br /> MAILING ADDRESS a 3 �T Vk Ke S I'tQ D r <br /> � r � <br /> PROPERTY ADDRESS <br /> �737D Aocr <br /> LEGAL DESCRIPTION(see tax receipt) 6T p a <br /> l�rn I CD CDn <br /> DWELLING/BUILDING ?� GARAGE/ACCESSORY STRUCTURE ADDITION w <br /> TYPE OFPERMIT(S): a <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> C <br /> S. <br /> STRUCTURE/ADDITION USE: ���`-Q CS0c!%E, 0 <br /> S 14 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: tt <br /> // 42 <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 <br /> O <br /> >1 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O CD <br /> C " <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). <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(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 ry <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS O 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. W W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z IW <br /> CONDITIONS OF PERMIT: o O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. W . <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. �a-a�-a 04(C, <br /> This structure to be used as private residential CD W m 0 (.a f m <br /> garage/storage only. Not to be used for human 3a <br /> 3 c y y o <br /> 7. habitation. o y m° ' <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m E D <br /> PP ( 9 Y ) Y Y C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of > m 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare thatI recognize �/ C$ m <br /> CD <br /> o <br /> that this information I am <br /> ac providing will be relied upon by the County C Bu e rt€opsin d minin whether to is-m ct <br /> sue a permit. 1 further accept all liability which may be a result of the C Ifo ation I am <br /> providing in this app'cation. I agree to permit cou officials charge i I r y n s or other ' <br /> authorized erson t have access the above a bed remises t an. easona th m E rn <br /> P pp spection. T o <br /> SIGN HERE Sf P 9 B m <br /> (signature of owner or build in contractor) (d e <br /> ZONING ADMINISTRATOR V IM an BURNETT COUNTY W <br /> ZONMG g `" <br /> TOWNSHIP PERMITS MAY BE REQUIRED irylal-led hN, 046p k� <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE Loi 1Skt.A CZ nor kp P <br />