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44 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator `0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> rn <br /> N r <br /> OWNER C f4'` yo 1 <br /> � I +-2p TELEPHONE _7IS- 43E (4303 d -�C <br /> HOME ADDRESS <br /> 8101 kkht� C'►(. t�akd�le. rIn/ SSI $ s <br /> EMERGENCY/FIRE NUMBER I3�� ROAD NAME RD6?(+S Rd. 1 <br /> LEGAL DESCRIPTION(see tax receipt) �a feel LOT 2 Sec+,;m 2y-T40 9)4 0 <br /> Ips <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE L^J ADDITION ❑ PRIVY ❑ rn o <br /> TYPE OF PERMIT(S): ' <br /> FILLING/GRADING 1:1CAMPING UNIT 1:1SUBDIVISION ❑ CL` <br /> n 5. <br /> STRUCTURE/ADDITION USE: &nsdU4u I (rrAr 4!e- 0 <br /> (Home/Cabin; Comnfercial Business; Bedroom; Deck;etc.) y <br /> 1 m <br /> BUILDING CONTRACTOR: TiL r&64CUC}�� M. <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> o = r <br /> x y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> m Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). CO) <br /> c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> v <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. P <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. C <br /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 53 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. (o o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENq 0 <br /> NEEDED. 0 3Z7 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <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.,ALLOWETH <br /> IN THE REQUIRED WATER <br /> SETBACK AREA. � � Val <br /> 6. 3CThis structure to be used as private residential / �`�'/// � = W " m <br /> s. garage/storage only. Not to be used for human 2• : 3 n 1 ,� 0 <br /> � m c m " o � 3 <br /> JU Z <br /> habitation. j ' 2 <br /> 7. <br /> A-Anno y <br /> Cl)= : [ m <br /> I declare that this application (including any accompanying schedul n examine me to the best of my ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that I s le for the it and accuracy of c <br /> all information contained in this application(including any accompanying s�l �} are that I recognize e m m <br /> that this information 1 am providing will be relied upon by the County of Burne osin ViXtermining whether to is- l7 <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person-Whave access to the above described premises at any reasonable time for the purpose of inspection. T <br /> CD : <br /> m <br /> SIGN HERE <br /> re of own o building contractor) (date) <br /> ZONING ADMINISTRATOR w <br /> fn fn cn cn to to <br /> N N (li N N N Ut <br /> (! N O ul V1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />