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Ib1 ""`T <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z z <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> N .s <br /> (' J I - v ` <br /> OWNER SQ}�'T,C/t.( a•�d �v�r �.e.� vner TELEPHONE �(,3 - 3gc1_,t��3 <br /> HOME ADDRESS "ter 'S+ NUD ' "ac-,Q*.hm <br /> MN '563-7 I v z� <br /> EMERGENCY/FIRE NUMBER p�$ ROAD NAME e''p� �� m <br /> 43a 5 J{5a 85 5� -Ho-l�,-v� <br /> LEGAL DESCRIPTION(see tax receipt) SO-1 -rA40/R 1 b t0 +e-es .-$b Lor .4 csm t/ i I cmn <br /> n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE;KADDITION ❑ PRIW El ' ( u1 <br /> TYPE OF PERMIT(S): <br /> rr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ UBDIVISION El a <br /> STRUCTURE/ADDITION USE: Qa�QQP_ 3(D l <br /> Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> m <br /> BUILDING CONTRACTOR: SELF or <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> -A in <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> TCL C <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C7 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). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v a <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> L <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> 0 <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 WATEO s-' <br /> SETBACK AREA. <br /> 5. This structure to be used as private residentialCL _ r o o v <br /> 6 garage/storage only. Not to be used for human / �� /O n 7 �• 3 a � a g M <br /> habitation. 'f / k C o `� g,� 3 <br /> 7. �Y/� 4 <br /> & . zi y 12o : <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my a5 g . ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m c <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- D <br /> sue a permit. I further accept all liability which may be r th"gunty of Burnett relying on this information I am ? m <br /> providing in this application. I agree to permit coin I Fgldd ng county ordinances or other m E E <br /> authorized person t av ccess to the above des r n e for the purpose of inspection. r <br /> m : <br /> n r7 <br /> SIGN HERE 1 /— 2-0 <br /> (signatu owner or bulidft=cf6h (date) <br /> ZONING ADM ISTRATOR <br /> ;. U fn to w in fn-0-• <br /> N NCn NN (1�N <br /> (� r fT IT O fly f! O O <br /> T NSHIP PERMITS MA BE REQUIRED I�} 0 0 0 0 0 0 0 <br />