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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O _ 1 <br /> ! TELEPHONE <br /> OWNER AR K -� M , chP% ��ale r9ti/s1 <br /> / m O <br /> M1r4 <br /> AILINGADDRESS 4j 0 CAL V /rJ �N62oue !475 MAJ SSd7.� (� <br /> C )M <br /> PROPERTY ADDRESS 5/ 9 r 1'P71A16RyA CI X C-/e- /2.4AJ6u4 y 1)/s c s993v <br /> T 41 Aj LAj C RF 30P6. <br /> LEGAL DESCRIPTION(see tax receipt) �.� C s 1Vl wL q /lV 3(0 7 3 9 _ <br /> M <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREj ADDITION ❑ c l <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> STRUCTURE/ADDITION USE' <br /> 5-T6A4667 5M�D iloxl2 N (� <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) w <br /> BUILDING CONTRACTOR: 01 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 V <br /> Om <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE c <br /> NORTH(N). y O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 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. <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 2. o , <br /> MUST BE SIGNED AND DATED BY THE OWNER. �b lll(((�j�� <br /> uz <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY RF nONF WWFN o I <br /> NEEDED. This structure to be used as private residential <br /> garage/storage only. Not to be used for human o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELC �J! <br /> CONDITIONS OF PERMIT: habitation. I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (1` C�y <br /> ISSUANCE. v SL <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 /> 4. NO STI UCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA Q ^�( } /s1) ,/� /&t /49� <br /> 5. (Qf _s� --�! UiGr U /Gt Ce J m w r o 0> 0 m <br /> 6. > (oat , fr-t-m c e jer 6 F f n c<)ns/7�/0 Taa�(. 3 n� � <br /> m C <br /> Z y N O O O <br /> 7. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize `: CD <br /> 0 m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G) <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 0 : <br /> authorized person to have access to the bove described prem' s at any reasonable time for the purpose of inspection. m o <br /> m <br /> SIGN HERE c <br /> a <br /> (sign re owner or (ding c t actor) (date) <br /> ZONING ADMINISTRATOR /n a h) <br /> O O <br /> U O OH 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />