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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> C <br /> OWNERV u //1/ W A D TELEPHONE 7 1 S' <br /> }1J O <br /> MAILINGADDRESS 7 9P / L rR 4 WP- -t /,,, <br /> r � <br /> PROPERTY ADDRESS H71 <br /> s' ay/r�o �R �� w 6h e5 6 ve, 7 9; p <br /> LEGAL DESCRIPTION(see tax receipt) o! 9!00 L a-r .2 GSM L-' P �0 7 �✓y <br /> 42 /y <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ® ADDITIONCL <br /> ❑ N <br /> v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: <br /> ( e/Cabin; Commercial Business; Bedroom;Deck;S etc.) (n <br /> C m <br /> BUILDING CONTRACTOR: e l o d <br /> v <br /> m <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. p <br /> -IO m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. Q1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED 9P.FILLED. N (� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CTON <br /> ETC.,THE PLANS XJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. ` 'c 0 r� <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �� / !/ o <br /> CONDITIONS OF PERMIT: QTR avvj <br /> /Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 2O'v�t�/', CQ <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 /> PERMITTED. c1 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER l <br /> SETBACK AREA. sdAm N �/M n <br /> 51 VnJ ��Y��� ,'�/r'(x� This structure to be used as private residential M W 0 0 o a o M <br /> b garage/storage only. Not to be used for human 3 n Om � a <br /> 7"`1 �J) habitation. z ° o 3 <br /> ���Y D-F��n � o = m <br /> declare that this pplication (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of W 0 : v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o 0 <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 1 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. Cn :- o <br /> m m <br /> SIGN HERE 3 . <br /> n . <br /> (signature o caner o building contractor) (date) <br /> ZONING ADMINISTRATOR / <br /> 616 h/4 <br /> 4A(A <br /> N <br /> CNO O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0c a 4-h2)0" <br /> o cn v o 0 <br /> l V'40 G--zce a9� <br />