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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ^ r <br /> CDrn o <br /> m <br /> c <br /> OWNER IONt-� O tv TELEPHONE (0,5-1- 37r &76S' o <br /> j " O <br /> MAILING ADDRESS OX �St� 5 s 3 - o 4 <br /> r CD <br /> 0 <br /> PROPERTYADDRESS <br /> u Dt / <br /> L L5zZ 3w4 <br /> LEGAL DESCRIPTION(see tax receipt) L.ol o-6 f P14 of QG,,t^s e'• .� 6, � J <br /> DWELLING/BUILDING �z GARAGE/ACCESSORY STRUCTURE M ADDITION ❑ �tn ° �- <br /> TYPE OF PERMIT(S): a 1 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION41 <br /> ❑ <br /> STRUCTURE/ADDITION USE: tyQiM'L YyIL �/��� cJ I' C 0 W <br /> I //•(H eeJ/Cabin; Co mercial Business; Bedroom; Deck; etc.) (n <br /> BUILDING CONTRACTOR: wl 4fsTOM owy%e- S o-11!j�-463 -132-q r-1IS-03 9' <br /> S-7,010 14w--i 13 SGS WT S4VV -1341 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n U w _N <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> M w "s <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a I <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). (n 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 9 <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. P <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. o <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. Io f t <br /> q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o >' 7 <br /> CONDITIONS OF PERMIT: <br /> W I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT d <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. -1:11ln d <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY /? to <br /> PERMITTED. _D 4 <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 /> A aoOrDODOa <br /> 6 habitation. D a n F a <br /> p <br /> o m C N `� 5, <br /> Z c <br /> 7. mm <br /> 2121(n: <br /> I declare that this application ,,,ciuun, a„ auw... a.. ... ��..�,,.� .,ate «,. a,... to the best of m � ^ O <br /> PP l y Y t r e / � ...a .. Y O� C <br /> J <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o ;a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (n 17 <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 Q) o, o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other r <br /> authorized person tb have access to the above described premises at any reasonable time for the purpose of inspection. m 'n <br /> -n <br /> CL <br /> SIGN HERE <br /> fN(AJ,fCOA T dWCTi fiWCAn CL <br /> ZONING <br /> ZONING ADMINTOWNSHIP PERMITS MAY BE REQUIRED(sin a of ownerobuilding;ontractor) (date) <br /> IST TOR D�NCT <br /> NiOO <br /> THIS PER11�1SHALL 11 �EX��R�Of1E_YEAR av FROM l i 00��n CfE�ei <br />