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ON COMPUTER/SCANNED <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> N <br /> OWNER �Ly)+l I I I C1.I�Yl S TELEPHONE O <br /> c� I <br /> MAILING ADDRESS 1 TUi — l `' /pp� / o / <br /> �l.Y�`2r.z1��1�Q�Si I o v}m <br /> PROPERTYADDRESS » <br /> (� <br /> LEGAL DESCRIPTION(see tax receipt) ]"4L�,^ Q 4) Pao Id <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION 116116c-� St0( w o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <: <br /> STRUCTURE/ADDITION USE: C D/3 5 L&qz <br /> (Nd/mJ a/Cabin]]Commercial Business; Bedroom; Deck; etc.) m •`. <br /> BUILDING CONTRACTOR: No���.�QA/), I1U� I(J_IOL6 <br /> m <br /> v <br /> m <br /> PLOT PLAN MUST BE PROVIDED LEAST AN 6'/,X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> m <br /> 0 » <br /> A v <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) p � C <br /> mn <br /> mz <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). C 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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO v 1 O <br /> BUILDINGS, ROADS,LAKE, LOT LINES. (� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS Y 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 o <br /> F <br /> O 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> This structure to be used as private residential <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. garage/storage only. Not to be used for human o 7 <br /> CONDITIONS OF PERMIT: �C' I <br /> habitation. �q p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ^� t <br /> ISSUANCE. <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 /> 4. NOSTRUCTURES,UCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. •T,. <br /> / oN CFpnj� mPi3 =0c =s. ] , S ��( <br /> 7. Z;l <br /> M <br /> = n m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �! C <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n ; c' <br /> all Information contained in this application (including any accompanying schedule)and I further declare that I recognize [ m E I : ; m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasona n. I [ <br /> _ n : <br /> SIGN HERIQ JA \ m D <br /> n <br /> EA n <br /> (Siap6tuj.of owner ui contractor) (date) 0 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY C� <br /> T S PERMIT SHALL EXPIRE ONE YEAR FROM�TE ISS � G <br /> rn +4 1,e f4elur O4 <br /> 1 - 3-0b <br />