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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m ° z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> o <br /> N <br /> C <br /> �� TELEPHONE Ll�7Z.Z'Z 4+1 tell n <br /> OWNER 0 Q ' <br /> MAILING ADDRESS H,v r►T (" O <br /> PROPERTY ADDRESS --2--1Q, I 1 PA rJ 1 Fit— 'K—\t-365- EYTe� W <br /> � I <br /> m 1 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ 1� o <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> o <br /> STRUCTURE/ADDITION USE: SYk'E'C> YJ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) C <br /> BUILDING CONTRACTOR: `i�t_F <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 < <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. OW <br /> I'0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T n n <br /> - I <br /> ?1 17 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n R A <br /> ; <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ; <br /> � DO .� a <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (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 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 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 j, o ` <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> o 0 4Z <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. S <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° c <br /> CONDITIONS OF PERMIT: <br /> O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q <br /> PERMITTED. d <br /> 4. NO STRUCTURES, INCLUDING RETAIN"^I(=\^gel I c PT(- AI I r)XA1Pn\AIIT4JIKI YWP: DG/11 IIRFrI\A/4TCD <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. <br /> garage/storage only. Not to be used for human M C d d 0 o a f m <br /> 6, habitation. .5 c N Coy 3 <br /> 0 0 : Tom :7. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my :` G) 2 i _, i c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ` m c m <br /> all Information contained in this application(including any accompanying schedule)and I further declare that 1 recognize U3 CD <br /> N <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- vv ? o <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 w <br /> providing in this applicatio reelert co officials charged with administering county ordinances or other <br /> authorized person to a accesib prem' n reasonable time for the purpose of inspection. c <br /> T <br /> m D ; <br /> n : <br /> a : <br /> SIGN HERE date <br /> { atujrb Idi contractor) (date) ? <br /> ZONING ADMINISTRATOR <br /> lI nen <br /> �EA di fA fA N <br /> O'O(TO � (WJwO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DgT,E OF ISSUANCE 9—1/_ U5 <br /> Rm- - -1�Imo-/ 1FICLed tO by I�L'1-0 �0(6PP % KJ <br />