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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 3 <br /> r <br /> y O <br /> OWNER B\ UC'li S( . 114 TELEPHONE ( DS� <br /> d <br /> �j <br /> MAILING ADDRESS �3�0 Mc2 K t ti Z 1 � I`oast SS(.bn'� VIL r�l 1 <br /> `�`! <br /> r m <br /> PROPERTY ADDRESS d 0 33 //��o I•��YI 1 ��Ct, 1 0_ <br /> LAKE Mc1�6NZT_E B6MGH &Utj3 ko I CSM � 13 — ; <br /> LEGAL DESCRIPTION(see tax receipt) �. <br /> IP I1lo �IU 1s 3+kV Ct Ri-KII��77II( J-PK-1 GkY'iSvlew KIUC. n� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE LTJ ADDITION ❑ N 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a' <br /> STRUCTURE/ADDITION USE: GiA/Z Q 4� (�r)h Iy 0� <br /> Q C, (Home n; Commercial Business; Bedroom; Deck; etc.) W <br /> J11 <br /> BUILDING CONTRACTOR: m <br /> v U <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 'n <br /> � y <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) O m <br /> r a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 iu A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m !? <br /> NORTH(N). C (O O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO Cn m ` 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. \ o <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. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. OQ Nq- <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. /O <br /> o <br /> v � ' <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <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. r `, <br /> \ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 6 N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ' <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,At I OWFn WITHIN THF RFOIIIRFD WATFR <br /> 5 SETBACK AREA. This structure to be used as private residential <br /> only. Not to be used for human x to o n v n o <br /> garage/storageY• r v m cmmc, ma * m <br /> 6. habitation. ; x 3 M m x a A <br /> v om CH � 3 <br /> 7. Z c m' � D �2 ={ <br /> o m [ m <br /> I declare that this application (including an accompanyingscneoule nas Dean exammect try me ane to the nest or m — � I 0 <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 1 m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i im in <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> m <br /> authorized personave access bove described premises at any reasonable time for the purpose o inspection. <br /> m a : <br /> m D : <br /> SIGN HERE �`1 - _7 � i� 1'Cw7v <br /> (signature of owner or building contractor) —�It/ (date) ' o <br /> ZONING ADMINISTRATOR���X,Lf�cn l/(�.((� /� E <br /> TOWNSHIP PERMITS MAY BE REQUIRED O o N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> 4640 a(' 'herml'-e SPS ED 739!5rni(S-s ' <br />