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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v C) Z <br /> APPLICATION FOR LAND USE PERMITS 3 14 <br /> �ia5 <br /> N <br /> CD <br /> OWNER C11 ,�G�c�C ��� © pv TELEPHONE �� - �f f�6 C� <br /> Np87�osv/ylymm0 M <br /> MAILING ADDR �07,791'94eC �FR�i9D f�ANl3oiE'!/{�i 55��3© <br /> PROPERTYADDRESS ,`979f 7,?GUFF i�FrP0�9D <br /> t 07"�,sEcrioN q� �V56/11 r19T,;4" 1 N rf16 - cr/o.V TvwiVsisilr <br /> LEGAL DESCRIPTION(see tax receipt) r&r gAlY,k'/7,#jC5-7 TO&//Y df OIYiOxl 130i9ryEtr 60' <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING CAMPING UNIT 1:1SUBDIVISION ❑ n <br /> OL N <br /> STRUCTURE/ADDITIONOSE: Z � o <br /> (Ho /Cabin; Commercial <br /> �Business; <br /> Qedroom; Deck;etc.) (n � -,!Z (r) ' <br /> BUILDING CONTRACTOR: <br /> v <br /> v) � <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. T r. <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OCD < G�. <br /> n o <br /> TIN Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 030 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C S � O <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m l� 1 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Uj Z <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. 1 <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 "D 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. Oho <br /> o o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. ^� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1 <br /> CONDITIONS OF PERMIT: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 1\ I <br /> ISSUANCE. }`yNll <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 /> 6. garage/storage only. Not to be used for human (D W 0 v a m m <br /> v v <br /> 3 a <br /> habitation. c N N o = 3 <br /> N <br /> 7. Z a N O : =O —{ <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my y,� A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 1 iv in c <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize p (D o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- v' <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 w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to ave access to the above described premises at any reasonable time for the purpose of inspection. m <br /> CD o : <br /> SIGN HERE <br /> (signature?NSHIP <br /> uil g r) (date) o. <br /> ZONING ADMINISTRATOR / d <br /> fA Ln NAM 0 N <br /> / N N N N O O <br /> �/ —G '. NO M UN OO <br /> TO PERMITS MAY BE REQUIRED CC <br /> leu <br />