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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator T o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 763 -3&o-1Vs y <br /> o <br /> C o <br /> OWNER —�h 0/"lf ek &S TELEPHONE N76 t 41t1G6��j-35y3 <br /> MAILING ADDRESS A ye 5 uj CG4 r� 15t M <br /> CDo <br /> PROPERTY ADDRESS <br /> W I <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE�K ADDITION ❑ _ ' u) 0 <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <: <br /> N <br /> STRUCTURE/ADDITION USE: C'-r~er6'q Q ° l� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) U <br /> �. <br /> BUILDING CONTRACTOR: <br /> m r <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 'ttv? <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p l <br /> 0 C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> T p rn1 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m Q <br /> NORTH(N). 'D o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO R1 <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. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. F r1A <br /> o Ci <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 19 <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. 0 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,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 <br /> M Co cC W 0 M a * m <br /> s. habitation. � 3 a � x a <br /> 0 <br /> 7. O N to <br /> m <br /> 1 declare that this application (include„y a„1 ..dam Urr.. eAdunneu Uy life dnu to me best of my (1 A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m r�i C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 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 oCD <br /> ' <br /> providing in this application. I agree to permit county officials charged with a tt€ or other <br /> authorized person to have access to the above described premises at any rea ti e o e ion. m o <br /> T <br /> m Dn <br /> (D <br /> SIGN HERE <br /> gn ure of r or building contractor) �A I 1 ,� AfY�@) <br /> bu <br /> ZONING ADMINISTRATOR 1 1 LUVJ <br /> BURNETT COUNTY �'! <br /> O N N W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING O o O <br /> THIS PERMIT SHALL EXPIRE ON7,YrR FROM DATE OF 1$SUAACE <br />