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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> - o <br /> w <br /> c <br /> u N <br /> OWNER �.,�-�.� �ui -� INC.• TELEPHONE 71s-J/6P -f- 17,7 0 <br /> m <br /> m <br /> MAILINGADDRESS/3y FO <br /> No coctHrY RD. s�tFu l�IXe, tet/ s-�?7/ <br /> r <br /> 0 <br /> PROPERTYADDRESS GL—r,4,0t/j gyp/ ,f20oW, 5AR4.4011. "I S-yQO/ 1 <br /> MacQ* ozy-3 no—oS tilo Q3` —E <br /> LEGAL DESCRIPTION(see tax receipt) Lora e5M V14 P44-G.ourreor6 S/o T39 R14 � I ) R1 <br /> d <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE UCI ADDITION ❑ o <br /> TYPE OF PERMIT(S): c <br /> 0 <br /> FILLING/GRADING 0 CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: &p yf Ei�GA-1 N f- (s-14QJ4C-F 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) W R <br /> BUILDING CONTRACTOR: (d7X74 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. OT 3 (n <br /> M c J <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) p m <br /> T n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> C) 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). <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. j o <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. tJ <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. a <br /> n F <br /> o W <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> 6 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ' <br /> z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <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. This structure to be used as Private residential <br /> 5. garage/storage only. Not to be used for human <br /> ;tl m0 � D O DO y <br /> habitation. ,a c d d . M a f m <br /> 6. m, D3 C 0c- <br /> 0 <br /> aA <br /> 0 omN .`" 053 <br /> 7. Z <br /> a [ T� m <br /> = m <br /> I declare that this application (incluamg any accompanying scneatue) nas peen eaammeo oy me ano ro the best of my 2 D <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of [ m n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E [ i m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> G <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m : o <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other m `" <br /> m m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T a : <br /> m D : <br /> SIGN HERE <br /> n ure of r r building contractor) y (date) 0 <br /> ZONINGADMINISTRATOR <br /> 00,0 � , <br /> O N Ut W W N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o u o n <br /> TKJkPERMIT SHALL EXPIRE ONE Y AR FROM DATE OF ISSU <br />--- - -„-K—M' -4 le+4+ (- mai led -0 � �rP-K B,,�t�” E <br /> is 4-1�-d b -T,�f-- <br />