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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> CYT o <br /> _ {— 1 1 N <br /> OWNER ..l t' TELEPHONE 61'x'Ln I g " 0 76 v <br /> m <br /> MAILINGADDRESS iaq -n sti,. s4. S*, 4,**#�nr I mm `(7�-;, r O <br /> PROPERTY ADDRESS Ste('R3 O 1 0 5Z <br /> LEGAL DESCRIPTION(see tax receipt) <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ADDITION 1-1 `' N�0 <br /> v � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o. <br /> STRUCTURE/ADDITION USE: S'>;"p 0 <br /> (Ho /Cabin; Commercial Bu 'ness; Bedroom; Deck; etc.) to <br /> m <br /> 2. <br /> BUILDING CONTRACTOR: n W V�?X W <br /> P' <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. O y O� <br /> r1I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m © p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE O <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m lTi <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. 9 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I <br /> BUILDINGS, ROADS, LAKE, LOT LINES. OP <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 0 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. £ <br /> O � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o ` <br /> NEEDED. a 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: QNB <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITQN- <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <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. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> AM 0 D O D O a <br /> 6. habitation. m F 3 n m x a z <br /> v omC: ." ogic <br /> 7. Z ee, - o � �o <br /> P <br /> I declare that this application (including an accompanyingscneaure nas oeen eaammeu o me ano to me uesr of m <br /> PP ( 9 Y 1 Y Y i !7E : v : C <br /> knowledge and belief It is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n 2 N A <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize m ` mo <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 <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 described premises at any reasonable time for the purpose of inspection. <br /> m <br /> � i D [ <br /> SIGN HERE <br /> (sjppat re of Owneyr,buildingf7c�tractor) (tlata) i i <br /> ZONING ADMINISTRATOR VI In,^, <br /> 6 -opt N�n� +� a8788 ON U9 WA M <br /> $-06-ax Pv4C Spey( 9 TOWNSHIP PERMITS MAY BE REQUIRED o v o u <br /> S-1-6`4 3 �,td TH� RRMIT SHA IRE qNE YE �j pOM�D�AnT�E O �1S �- <br /> 4-/1�L Dtt� aoOSS <br /> MIM rK I TI Y ' / 9(J <br />