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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _U c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> d <br /> TELEPHONE m � A5 O <br /> m <br /> MAILINGADDRESS �q �J n� �� S jdWEA r �� ���[�b Cn O <br /> { g �Y,, r /y � / C,`/p r ry m <br /> PROPERTY ADDRESS 3 fT' 1 . ��EL 71 O O J) )=14 t. L 00 o \ C1 <br /> r 9 <br /> LEGAL DESCRIPTION(see tax receipt) 5 /b/-rq D I l• 1a 0 L4 CSS rn <br /> _ - ��. n <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE A ADDITION ❑ ((n 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION ❑ <br /> 5. <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) (n <br /> BUILDING CONTRACTOR: T ,-rn SI^ eZyf-5S nDILS7ZQLIeDMi l v n <br /> U <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 Cn <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p n � <br /> n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;? <br /> NORTH(N). C Q) n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Qom) <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. C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN �» o <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> Z (7 O <br /> CONDITIONS OF PERMIT: I <br /> t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS. ETC.. ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 5' garage/storage only. Not to be used for human <br /> 6. habitation. g � v o g n m <br /> 7. Z CyCD X'o <br /> CDo = � -� <br /> _ P C : Tom : m <br /> I declare that this application (including an accompanyingscneouie nas peen exammea o me ano to the nest or m — � ' �*+: A <br /> PP ( 9 Y / Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of J o�O c0i � C <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize J CD Cm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- W: ` to <br /> 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 : 0 : <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> -n a : <br /> d n <br /> SIGN HEREori✓l <br /> (signature of owner or bttilding contractor) (date) <br /> ur (W <br /> ZONING ADMINISTRATOR V "� l Fla l�L'2n - I <br /> G �fA fA FA FA�N <br /> OUNiOC�n (�11 VNiO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMLT SHALL EXPIJRE ONE YEAR F OM DAT ppF ISS A� y E <br /> on k v / } d 1"791/ r 4f,"'we ,was <br />