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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator (D ° o <br /> APPLICATI N FOR LAND USE PERMITS 3. - 7! l <br /> r <br /> N � <br /> N (� <br /> C <br /> N <br /> '';�' fo5/-3o3ci8 = C <br /> OWNER TELEPHONE <br /> MAILINGADDRESS c—l..m A IC RiDAD PANS VJZ <br /> PROPERTY ADDRESS Siff SDUC Ll <br /> LEGAL DESCRIPTION(see tax receipt) T 5 a v 90 V �( <br /> DWELLING/BUILDING El GARAGE/ACCESSORY STRUCTURE IL ADDITION D <br /> TYPE OF PERMIT(S): CAMPING UNIT ❑ SUBDIVIIONS ❑ n <br /> FILLING/GRADING ❑ <br /> o <br /> o_ <br /> STRUCTURE/ADDITION USE: #4 lii5- AA <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) 2. <br /> r <br /> BUILDING CONTRACTOR: N N R C!F4.S12 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y,X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> < to <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. c ^ O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: AERIAL OR TOP VIEW) n 0 <D J <br /> -n o — Z <br /> 1. ALL REQUIRED DIMENSIONS OR DIST NCES TO BE SHOWN OR DRAWN TO SCALE. Im p A <br /> m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <br /> NORTH(N). to <br /> 3. SHOW DIMENSIONS IN FEET OF THE OLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ' a <br /> CENTERLINE OF ROAD,(C)BUILDING S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> LAKE,STREAM OR RIVER AND MEAS REMENT TO WETLAND AREAS. 1 <br /> 4. SHOW THE LOCATION OF THE WELL W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO C>? <br /> BUILDINGS, ROADS, LAKE,LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 0 <br /> 6. IF SEPARATE PLANS ARE SUBMITTEDBY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS O 2- <br /> MUST BE SIGNED AND DATED BY THE OWNER. f /r <br /> J V 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 1J� <br /> Z SS <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° 7 C. a <br /> CONDITIONS OF PERMIT: 3 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Con <br /> V V�1 <br /> 2. REMOVAL OR CUTTING OF TREES At ID VEGETATION IS RESTRICTED ALONG SHORELINE. J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY a <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAI qING WALLS. ETC.. ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 6. garage/storage only. Not to be used for human X u r > o a f W m <br /> habitation. a rase- m F 3 n m x n m M <br /> Z O <br /> 7. o m -n m <br /> _ C() <br /> I declare that this application (including 3ny accompanying scneaure) nas peen examrneo oy me ano to the oust of my (j O <br /> Y Lo <br /> 'knowledge and belief it is true, correct a d complete. I acknowledge that I am responsible for the detail and accurac of n call information contained in this applicati n(including any accompanying schedule)and I further declare that I recognize Urthat this information I am providing will a relied upon by the County of Burnett Wisconsin in determining whether tl am ' w ° <br /> sue a permit. I further accept all liability hick may be a result of the CountyCD co ET <br /> providing in this application. I agree to ermit county officials charged with i e n c t o i s her <br /> authorized pers access to the bove described premises at any reas p c i n. o <br /> CD > : <br /> SIGN HERE o <br /> (si ture of er or building contractor) <br /> ZONING ADMINISTRATOR <br /> w F;�Vl �N <br /> ZONING o � o�� o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS ERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE g a� <br /> � rmi� let ►'hall2d fo �Uhn X)e sin <br />