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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator m o o <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNER 1Q M�.S 1 I 4J�1 \lT�\ R�N� TELEPHONEsi- `°1 g`� or, v' <br /> � <br /> ° <br /> MAILING ADDRESS <br /> 0 <br /> / y� 0 <br /> PROPERTY ADDRESS VJ3n`l - M��O W N 1 \ ) <br /> LEGAL DESCRIPTION(see tax receipt) , (°��b�1 `�r� ��►f 39 R, a 6 1 � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE K ADDITION ❑ r 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> ( <br /> fkN 42 Com- >o <br /> STRUCTURE/ADDITIONOSE: POLL Q1R '> <br /> ��� (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: t,Q \ " IA NN RU I L.d IN :� i N/ <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0n <br /> m <br /> ?i Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m mo <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE c <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 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. f'0 F <br /> v -,O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC"_ MAYBE DONE WHEN <br /> NEEDED. r c;u 1,77 "- <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. F-j Cl III o lI� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER �'J L' ZOOS <br /> M� II in <br /> ISSUANCE. r' Uj <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SH614fiNETTCOUMTy <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. ZONINGG <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER t <br /> SETBACK AREA. <br /> 5• This structure to be used as private residential <br /> CIC. ( M 0mat7rn <br /> 6 garage/storage only. Not to be used for human g N , „ rl a m <br /> LD. <br /> 3 a m �c ^: . 70 <br /> habitation. y �o 5 <br /> 7. o m <br /> c� E E E <br /> declare that this application (including any accompanying schedule)has been examined by me and to the bD <br /> est of my L7 c C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m , : "): <br /> CL ra <br /> cn <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E 1 o : 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 I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> : <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m co <br /> - o : <br /> U CD <br /> ((la�� m : m <br /> SIGN HERE 02) �' m <br /> (signatu wner or building co ctor) (date) <br /> ZONING ADMINISTRATOR <br /> fA fH EA FA ro <br /> In(�� ,w�L, I�U� TOWNSHIP PERMITS MAY BE REQUIRED <br /> Q6.Q, s�nl-' THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />