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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> y O <br /> N <br /> OWNER G p Yom( k M N e I <br /> ` Oh I r tCt V' TELEPHONE c n <br /> C t r m <br /> MAILING ADDRESS � "l 2 ev � �� �, W AI LA S-Y�3 v O <br /> CD <br /> r CD <br /> r en 0 <br /> PROPERTY ADDRESS cl 142 S- owe+� i�C IA , N <br /> Q <br /> LEGAL DESCRIPTION(see tax receipt) O <br /> m <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ® ADDITION ❑ rn 0 <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n '� <br /> STRUCTUREIADDITION USE: toCcr¢i c L 9 LN 0 <br /> (Home/Cabin;pCommerrcial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR PI NS &At h0 �t)a ��-` wr �Y$r[3 2. <br /> 0, <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n3 Q <br /> :O N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p CD O <br /> n a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a <br /> 9t X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(Na)AND INDICATE m CD <br /> NORTH(N). y 3 <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. 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. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: Rp <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE, a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS.ETC..ALLOWED WITHIN THE REQUIRED WATER <br /> 6 SETBACK AREA. This structure to be used as private residential <br /> garage/storage only. Not to be used for human A co 0 r a o a o v <br /> m C o m 0 m n F m <br /> 6. habitation. ; z 3 a Om x9 c <br /> -o omcy `.° o � �+ <br /> 7. Z c �, � o : � t01 <br /> I declare that this application (including an accompanyingscneau�e nas Dean examines o me ana to me best of m - �+: A <br /> PP ( g Y / Y Y C) c -4 , C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofo'd <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD - : 0 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this irtf m w :` o <br /> ' <br /> providing in this applic on. I agree to permit county officials charged with adminis r o m <br /> w : <br /> authorized person to h acces t the above described premises at any reasonabl r s i c `D <br /> n : <br /> p ��f l _ a : <br /> SIGN HERE �G Lev imp y 0&— <br /> vt : a : <br /> (sig tur ofo r building contractor) O^T Bat <br /> ZONING ADMINISTRATOR <br /> URNE� CA W W <br /> TOWNSHIP PERMITS MAY BE REQUIRED B ZONING OO N N CWT (NT O <br /> THIS PERMITS ALL EXPIRE Q E YEAR F M AT F I UANCE <br />