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Burnett County 7410 Co. Rd. K, No.102, Siren,WI 54872 Office of Zoning Administrator 'n 02 <br /> APPLICATION FOR LAND USE PERMITS o Z <br /> r c <br /> C <br /> c !n <br /> m �\ <br /> TELEPHONE (O�� —7/,,-7 7 0 <br /> Id T i l tv W Q <br /> MAILING ADDRESS p� -'7 � <br /> Q <br /> PROPERTY ADDRESS 'g-7 ) (0 <br /> n , y <br /> LEGAL DESCRIPTION(see tax receipt) W 11 lJZ /� ✓\/ X/, CD <br /> v> <br /> ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ O ` <br /> DWELLING/BUILDING C� (/� 0 <br /> TYPE OF PERMIT(S): c <br /> Q <br /> FILLING/GRADING ❑ CAM/PING UNIT ❑ /SUBDIVISION ❑ a Q <br /> STRUCTURE/ADDITION USE: �(,(.d' �y 31I X J� I CtO?lri(' <br /> q� p,(dome/Cabinn,;oCommercial <br /> rBusiness, Bedroom; Deck/; etc.) � (n <br /> BUILDING CONTRACTOR: ,)/YY7�/r CJ�• 1� �CJ/ J3T4 hL / /'�//� Sc OW <br /> m <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> � m ) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 m <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 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m3 <br /> CENTERLINE OF ROAD,(C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF J Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. IQ> <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <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. F <br /> O 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <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 <br /> CONDITIONS OF PERMIT: (� O <br /> habitation. o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ti <br /> ISSUANCE. p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <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 /> S BACK AREA. 'l `I <br /> 5. �IWCi 14R 7r�yL `t" STU/ 1�j0 rGf� Q <br /> 6. f N I I � JVM /Yi�'trL m � aomxa <br /> omCN `� o � 3 <br /> Z c m m o —1 <br /> 7. P ;o <br /> = cn : 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 v n o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m W <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 m o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized persorllQjiave a cess to the above described premises at any reasonable time for the purpose of' spection. m <br /> -n a : <br /> CID a <br /> C� m <br /> SIGN HERE 2 �� n <br /> ign ure of own r wilding contractor) (dat i <br /> ZONING ADMINISTRATOR <br /> ma.I e o Dftr�� � r�N <br /> L O N C P W W N O <br /> PVO 01001 MCA O <br /> TOWNSHIP PERMITS MAYBE REQUIRED �rLP�S4"onf �r �` ""`�' ( o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />