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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 /> N <br /> N <br /> C / / C <br /> OWNER J L l m/Y! TELEPHONE ,j/— 7O 2-�Z/ Z <br /> A' ^ n / O <br /> MAILINGADDRESS Cq DV�LAAIZ) kw � j#4PGCWDD0, rI1NA1, �7��� � 0 <br /> f SAT � �E 1, 4#JE <br /> PROPERTY ADDRESS E fit? p � <br /> PA RCE 4 1 SE y S d/ SEG. 8, - owNS irp J No <br /> LEGAL DESCRIPTION(see tax receipt) C 9A A)q E ulE57, F'icFFz( Gt U7 3oD-Cid U <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Ly ADDITION ❑ (n <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING 1:1CAMPING UNIT 1:1SUBDIVISION ❑ / oo0 a `_ <br /> STRUCTURE/ADDITION USE: GR afZA if 75OLS ,�Eyt(Lrp WQ ?0Awdmhs 0 <br /> (Home/Cabin; Commercial Busine ; Bedroom; D ck;e (n <br /> BUILDING CONTRACTOR: f q n�E au6 `'1 /951) t4Xl-/AM 1 . D IL <br /> GFM FA/7 SLA3 (A)Dd p- AAmG Vjaii kha- v � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> ;l N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m p <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 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. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o E <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN O <br /> NEEDED. 0 <br /> II) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o W <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5 SETBACK AREA. This structure to be used as private residential <br /> garage/storage only. Not to be used for human ; d iu > o a 0 m <br /> 6. habitation. m 3 a m `s aT. ;u <br /> C om o = 3 <br /> MW 00 <br /> 7. o -,:2m <br /> I declare that this applica. _ _ amined by me and to the best of my y A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 2_ e, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ID o W <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. I further acc pt all liabili hi In may be a result of the County of Burnett relying on this information I am m <br /> providing in this applicat n. I agree t p I ounty officials charged with administering county ordinances or other <br /> authorized person to he a scribed premises at any reasonable time for the purpose of inspection. `D (n <br /> -n O <br /> TCD <br /> SIGN HERE <br /> Z <br /> n <br /> (sl at re of owner ilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N (TNN O O <br /> (TOtT (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />