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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> rn O <br /> c v <br /> 8 I n <br /> OWNERp`( � ye n/� TELEPHONE Z O <br /> `= � O <br /> MAILINGADDRESS 1ZZkA Mn rninti `Bove L.n. E <br /> Z /� T i m <br /> PROPERTYADDRESS F^ �� t c- �' _`� y g33 �I�ati�� L � r ` L'� <br /> { <br /> Q <br /> _ <br /> Cn <br /> LEGAL DESCRIPTION(see tax receipt) S y r�? R L) /L 5 0) CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ c 4- <br /> TYPE OF PERMIT(S): (� <br /> FILLING/GRADING 1:1CAMPING UNIT ❑ SUBDIVISION ❑ <. <br /> STRUCTURE/ADDITION USE: S <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) c ` <br /> 2. <br /> BUILDING CONTRACTOR: v I <br /> CD <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. J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> T1 O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C CA a <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 4Z>Q-o <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. F 1 <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. ` <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PERMIT: \ <br /> 9 � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS. ETC..ALLOWED WITHIN THE REDUIRFD WATER <br /> SETBACK AREA. This structure to be used as Private residential <br /> 5. garage/storage only. Not to be used for human X m d r > o a o m <br /> habitation. D 3 a2 `r a m i <br /> 6. OS N N N ? _ 3 <br /> C y N O � q <br /> Z <br /> e ."0 <br /> 7. o o : �, m <br /> ,: A <br /> I declare that this application (incluuoig any accompanying scneowe) nas ween e>rlammea oy me aria to the best of my .� E c) c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am resp risible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule and I further declare that 1 recognize N m m0 <br /> that this information I am providing will be relied upon by the County of Burnett WI consin in determining whether to is- o <br /> sue a permit. I further accept all liability which may be a result of the County of B rnett relying on this information I am <br /> providing in this application. I agree to permit county officials charged with admi istering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasons a time for the purpose of inspection. m n <br /> m cL <br /> a : <br /> SIGN HERE <br /> (signal f owner or building contractor) (d e) <br /> ZONING ADMINISTRATOR I <br /> aoal7- 6a�w(� O U1 O W N N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED _ Jc(c{✓— <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF S AN E <br /> �rmr+- + jj? --der rnaI ted �o ar��nn 5-�-� <br />