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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 o <br /> APPLICATION FOR LAND USE PERMITS <br /> N 0 N <br /> C <br /> ♦` <br /> OWNER TELEPHONE . a7- �pfr n <br /> � O = —• <br /> 1C <br /> E) <br /> /� ✓rr-ilk/F/� /L,// -©/-�.1 ��� Sy�? 'T <br /> 0 <br /> PROPERTY ADDRESS _ q <br /> y66.8L ErT o/- 7Ki` g5t yc 6.£l r <br /> S �TH�✓�=��u�►T�0.0F r* ojr-S�I/Y, OIG SFcTLa✓7w/ <br /> CG DE RIPTION se taxrecel gra. ,S;��i3vN0�/*OJ'R�fK'�`- f�ShT����"�' ra O C <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE W ADDITION ❑ <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. �. <br /> STRUCTURE/ADDITION USE: 0.(Gtn ' <br /> (Home/Cabs ommerclal Business; Bedroom, Deck, etc.) U) Vl <br /> BUILDING CONTRACTOR: /V JILTL+f�E} 2 U T L�L <br /> -U <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o <br /> '-1 o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ° A <br /> m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> C o <br /> NORTH(N). m <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. <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 �. -4 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> O 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. l� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ' <br /> ISSUANCE. w <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Ip <br /> PERMITTED. C/ <br /> 4. NO STRUCTURES, INCLUDING PFTAINI[ lr_Wnl I c PT(-. AI I nWFn WITHIN THE REQUIRED WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. m � rr0Dom <br /> garage/storage only. Not to be used for human 0 N <br /> n 3 nm ;l <br /> 6. habitation. a o m c N o 3 <br /> Z <br /> C m � O � 2, =i <br /> P m Tom : <br /> M <br /> 7. - <br /> - � : �: p <br /> I declare that this application (including any accompanying scneouie) nas peen examinee Dy me ane co cue best of my J: O c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of _ m <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> CD <br /> providing in this application. I agree to permit county officials charged with administers c un i they <br /> authorized person to have access to the above described premises at any reasona p o t ^• m m n <br /> D i <br /> m 0 <br /> ` p2p0 to o <br /> SIGN HERE �Id�ate) rcc?)�o <br /> na ure of own building contractor) LWJI�AY 6 ZONING ADMINISTRATOR � NDBURNETT COUNTYu, o � � � o <br /> TOWNSHIP PERMITS MAY BE REQUIRE �J <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF'SS <br /> mailed' WA le U lrt;r / J <br />