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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 <br /> r <br /> to O <br /> OWNER I TELEPHONE n <br /> G�Mv`11�.1 -u Sty�� 715 - L�S 7 <br /> CD <br /> MAILING ADDREO <br /> SS ` ( S-(, (� <br /> G \ o <br /> PROPERTYADDRESS <br /> Locale -tie, uC I/-I cD ,� }hG Sl;- 1/y Sect <br /> LEGAL DESCRIPTION(see tax receipt) )VW n5 &,Aqe 2Mrfvte W (CIVIVI -u Ll/l <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ S' (n <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: �A otn E'_ Gv,\c—\ I`w\C l 1\t& 1'yP Gcx.r A U _ C <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cn <br /> BUILDING CONTRACTOR: 1\[�P.0 CLIA S t-CA(�tV V1 <br /> iU <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 t�` <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O lv C \ <br /> z y O J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> n <br /> -n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C) pq <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m Op , 3 <br /> CENTERLINE OF ROAD, (C) BUILDINGS)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v <br /> Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE,LOT LINES. C' <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 I ° <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <br /> o : V <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 2 41 <br /> (A <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: S 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <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 /> SETBACK AREA. <br /> s. &IArYYe •� yb — orr (?d��-at If,f r ,�� Orly P,c�derrle i <br /> m cc r > ODQ0 13 <br /> 6 G This structure to be used as private residential :X3 a a ; x a z <br /> a <br /> garage/storage only. Not to be used for human z 0 y C o N 6 3 <br /> 7. <br /> habitation. o CD m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me anu ry m. of m <br /> PP (� 9 Y ) Y Y C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d <br /> all information contained in this application (including any accompanying schedule)and 1 further declare that I recognize m mm <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ' (n <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 d o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ,o <br /> authorized person to have access to the above scribe remises at any reasonable time for the purpose of inspection. m n <br /> m <br /> CD <br /> m > : <br /> SIGN HERE _ '�(/ 'Q el ` a <br /> (sig ur of7own or contractor) (date) <br /> ZONING ADMINISTRATOR U <br /> NCCN N(T0111OT <br /> TOWNSHIP PERMITS MAY BE REQUIRED (/O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR F�20M/gATFS> ANC'Ey��rtisahGl Y6a 0 L/ <br />