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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U 0z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> '- r <br /> 57o <br /> OWNER / t 1 C l C-' l '' TELEPHONE IN f Sv <br /> 7 _2 I <br /> MAILING ADDRESS / �� 7 �y-F`J/L�/'�_ C.y�rid la%7�RN !jj 3 Y / O <br /> r m <br /> ;� p 0 <br /> PROPERTY ADDRESS Z SSI K +h y Ill u I.S r t t l�G( 6���Ufr O 2 <br /> LEGAL DESCRIPTION(see tax receipt) lido u3 G4� P �'��.L m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE JAI ADDITION El <br /> TYPE OF PERMIT(S): cr <br /> ( c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ c <br /> / <br /> S. <br /> STRUCTURE/ADDITION USE: t2 L^.�-�1� (� )C D T <br /> (y me/Cabin; Commercial Business;Bedroom; Deck;etc.) y <br /> (r' v <br /> BUILDING CONTRACTOR: 5P 4 <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. <br /> M0 J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> c) <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 <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. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS Q o <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MA1(BE DONE � L o VJ <br /> NEEDED.THIS PERMIT <br /> u t CJJ <br /> CONDITIONS IS 0 <br /> SUBJECPERM TT TO ALL CONDITIONS LISTED BELOW. St 2 'a <br /> P 2002 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMiyLji iNr 1­-1coUIy' <br /> ISSUANCE. ZONING' �} lv <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 /> SETBACK AREA. <br /> 5. This structure to be used as private residential <br /> X n aoav 'v <br /> garage/storage only. Not to be used for human " N ° r, M a f m <br /> A <br /> 6. 3n00CL <br /> habitation. . m c N o - 3 <br /> 7. . <br /> z n 0 <br /> p �I M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — N A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m o <n C <br /> all Information contained in this application(including any accompanying schedule)and I further declare that 1 recognize p m � o : mt7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- !Jv <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett retying on this information I am d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o <br /> SIGN HERE <br /> CL : <br /> CL : <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR i1111�r3(1 <br /> (fl fA d/fA � N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> X300/ Al � goo <br />