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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ID o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> rn O <br /> y <br /> OWNER �1�07"/�I S4 TEH <br /> �j/C.r/ !� /"• LEPONE <br /> MAILING ADDRESS 11-7-7 be-- 4J?K[J A19-, A(, <br /> PROPERTY ADDRESS ;2,9W& U• /C2G40- *0Q <br /> �GL �.!(or < .Ol�f00 HlS7oi2Y 4�34� 4R7v� <br /> 15E4-7 7W WfIe,t;!�S/, <br /> LEGAL DESCRIPTION(see tax receipt) ,elVot 6fo, 4 4C 7—y,*YP%-1/Nr11J 0074-OTS 1) CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE.YSJ ADDITION ❑ <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: l i�►9 -5� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: /'/✓ � �vlL�l'"� ' � �ai'1L Q <br /> /S/w2/ )PA }IwAeps ed/ "5 ; S <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y \ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT a <br /> o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> 0 <br /> 3. SHOW DIMNORTH ENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO M J 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFa•� o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. v.J <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 Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° V1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <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_ FTC.. ALLOWED WITHIN THE REQUIRED WATER <br /> 5. SETBACK AREA. This structure to be used as private residential <br /> garage/storage only. Not to be used for human X m v v> o a o m <br /> 6. o ° 3 ao n ao <br /> habitation. CD �o C:y o= 3 <br /> Z CD <br /> 7. ° m T m <br /> ' r» : . . A <br /> I declare that this application tincivamg any accompanying scneautet nas peen exammea oy me and to the best of myc C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize c m <br /> that this information I 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 I am iw : Q <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ° `D <br /> authorized person to have access to the above described premises at any reasonabt I m <br /> m ° <br /> CD�. a <br /> SIGN HERE a <br /> ign tut f ow r r building contractor) 'j <br /> (date) <br /> ZONING ADMINISTRATOR n <br /> r06 <br /> O N (I� WWNO <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY `� <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS U ING <br />