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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 71 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N 0 <br /> OWNER �C_ TELEPHONE711^63�-Ck8� 7 a <br /> O <br /> m <br /> n_ �('� ,, /� O <br /> MAILINGADDRESS f VQS I.�VAJ-CCA POA,J <br /> PROPERTY ADDRESS l <br /> LEGAL DESCRIPTION(see tax receipt) I-DT C ,0—S"( V 2 I 1 (n) &OU <br /> ��II <br /> DWELLING/BUILDING 1:1GARAGEIACCESSORY STRUCTUREX ADDITION ❑ V1 <br /> TYPE OF PERMIT(S): ¢ [- <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: CArzS f 'boA�S f {�L.Sf l�Ck 5��7f-Q- S7Ueh�� j <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) U) <br /> m � <br /> BUILDING CONTRACTOR: /Y1'Ir S <br /> (^ <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN BY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Tt O <br /> O <br /> M w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NS)AND INDICATE rh <br /> NORTH(N). C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <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. 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. I O <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 ) M <br /> MUST BE SIGNED AND DATED BY THE OWNER. o vV <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN g g .� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: I O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT _n j <br /> ISSUANCE. T <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 RETAINwn WAI I s FTc Al I nwpn WITHIN THF PPni IIRFn WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> s. <br /> garage/storage only. Not to be used for human A O r D OD 0 1) <br /> m c morn 0 of m <br /> 6. habitation. ; F 3 n m x `?' � L <br /> OS m C N N O = <br /> 7. Z y VI O 7 <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m ^ ! O <br /> PP ( 9 Y ) Y Y <br /> nci <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n : N C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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 �: m o I <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ,o <br /> authorized person to a access t the above describt1pratnises at any reasonable time for the purpose of inspection. m ' <br /> TI d <br /> DE <br /> SIGN HERE <br /> (s;tt� afore of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> J t ON W t P m O W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED O (n O N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR aFRO�ATE OE ISSUANCES b I !o <br /> —1r —Z—U---- <br />