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Burnett Courity 7410 Co. Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator -o Q Z <br /> APPLICATION FOR LAND USE PERMITS <br /> F <br /> N 2 <br /> H <br /> p / O <br /> OWNER TELE E —� <br /> m W <br /> MAILING ADDRESS / v FO <br /> PROPERTY ADDRESS <br /> 6 c� / 3 sem, V I a .a � <br /> LEGAL DESCRIPTION(see tax receipt)�• 3a Tye /� Ila T T irks Egktes- LD >` 4 m <br /> TYPE OFPERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE K ADDITION ❑ y3q in Ottf <br /> a <br /> FILLING/GRADING El CAMPING UNIT SUBDIVISION ❑ �� � <• <br /> �y N W <br /> STRUCTURE/ADDITIONUSE: r (VIP o' <br /> J ^ , <br /> ome/Cabin; Commercial usiness; Bedroom; Deck;etc.) En <br /> T/ ' � C <br /> BUILDING CONTRACTOR: N <br /> 'o <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X i i SHEET OF PAPER. ANY INCOMPLETE OR CD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn cD 1 <br /> NORTH(N). C 0 <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. ( ^ o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO "1 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. I O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADY 01� ( N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER, PLANS <br /> PLANS <) 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o f <br /> / ' <br /> 93 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF{ ATIONIWX BE ONE `�/ g <br /> NEEDED. �//''//f� 9 ' J U1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. UR/�F� C%4 �, o O <br /> CONDITIONS OF PERMIT: ® L' / <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITI 'Y//�G <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> yy <br /> R <br /> 4. FaNOSTRUCTURES, INCLUDING RETAINING WALLS ETC.,ALL IN THE REQUIRED_ WATER <br /> 'RS TBACK AREA. -7 y - —A7-4 P -- <br /> 5. {j This structure to be used as private residential <br /> �_ ---- garage/storage only. Not to be used for human m d w 0 m n v <br /> 6' habitation. ' " " n m <br /> n <br /> r — m Sam �c <br /> .� 'O C:N N O 7 <br /> / /, m J p <br /> 7: OP. N Q�7'l O N T`1G M <br /> I dec are that this a lication lncludin an accom an m schedule has been examined b me and to the bes of m Lj O <br /> PP ( 9 Y Y 9 ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy ofm c2i in c <br /> ail information contained in this application(including any accompanying schedule)and I further declare that I recognize m o C <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to isCD 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 � ` o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m ? <br /> Q O <br /> m m <br /> SIGN HERE y, <br /> (Signa ure_oI own or ilding con ractor) (date) n <br /> i/ w <br /> ZONING AD NISTRATOR- Im r IGI�/I/G{� // v <br /> ��C1S /K ' lflFn <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> Y b CA0 Cnoo <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE U) <br />