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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 3 <br /> r <br /> w O <br /> C <br /> rnnmER G zrg�d Kar TET'IONS �.51 7 7 0- 0 3 g 5' 0 <br /> d <br /> 1' _ 1 <br /> MAILINGADDRESS �c1717 N. ROW arj S+. i YYl4�nI2WOJd f kj? 5-51O 9 v <br /> 0 <br /> m <br /> -_ II 0 <br /> PROPERTY ADDRESS G g II S♦.A Wa. Tom• Z <br /> Loi'S Irl, , y , g1ocK 1 n{ 7a-nSoa�s LQ � Slor-e � � <br /> LEGAL DESCRIPTION(see tax receipt) D i i f .II '' [o n <br /> Iv Sion o D2y;1 S LriKt�q� Ourntrr 141114- WZ � m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ cc- 0 <br /> TYPE OF PERMIT(S): FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION El STRUCTURE/ADDITtONUSE: GCkraq Q. (3'+4L +0 64- deA , 30etyd� . - <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) U)p m <br /> BUILDING CONTRACTOR: �C;C� � �-grry o.+ ov Grt4 I�4QS(,h <br /> 42 � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> M y/ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <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. 9 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCES TO t <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <br /> S. 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 C �. <br /> MUST BE SIGNED AND DATED BY THE OWNER. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. IR <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Vf Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N G <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 /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential X d r- > o a o v <br /> 6. garage/storage only. Not to be used for human gCD <br /> 3 n g OX <br /> m C N y o 3 <br /> 7. habitation. o H M 0 tocn : A <br /> m <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my (j c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of iv 0 iv, <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m o my <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 w <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 reasonable time for the purpose of inspection. o : <br /> CD <br /> (D m <br /> SIGN HEREMiAA -3 ' <br /> sig ature of own or building contractor) (date) o <br /> ZONING ADMINISTRATOR <br /> N V�iN 169 IL4 <br /> 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED �V 1m <br />