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-Vwrnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> N O» <br /> N <br /> C <br /> OWNER J�Q �r L I i S t� TELEPHONE 715 — ,91 — 34414 <br /> MAILING ADDRESS J 1 '410V <br /> yr �� O <br /> 1� �Y. hG (pr-Psi 1J.41/ Lh 'DAve <br /> . �hV� <br /> GJ <br /> PROPERTY ADDRESS SA YVI <br /> SC Sri 'fry a7 —yo- �y_ e �•-S I�7cSdrlaa <br /> LE GAL DESCR I PTION(see tax receipt) r. .- SP1-:'10 dd.= :40CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 9 ADDITION ❑ c 0 <br /> TYPE OF PERMIT(S): tr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> / �❑ <br /> STRUCTURE/ADDITION USE: =)C'M-GO 41 ix �� 0 J �\ <br /> (Home/Cabin; CoWnercial Business; Bedroom; D ck; etc.) m \. <br /> � i 1 <br /> BUILDING CONTRACTOR: b A) N e,r <br /> -U <br /> (D <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. O — <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0c <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). � 3 <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 !Jj Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q) <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.C i <br /> MUST BE SIGNED AND DATED BY THE OWNER. 7� 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <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. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY r� <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 A m 0 r- D O D o <br /> 6 habitation. 0 3 a F a A <br /> Z ON O _ q <br /> 7. O N :�`C : ;a <br /> 1 declare that this application (including an accompanyingscneawe nas oeen exammeo o me ano to me nest or m — d A <br /> PP ( 9 Y 1 Y Y ? L7� : v ; C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n � <br /> a <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize ID m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0Cn <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or othero N <br /> authorized person to haye access to f he above described premises at any reasonable time for the purpose of inspection. CD 'n <br /> T <br /> 3 <br /> SIGN HERE 0 <br /> ( ' ture of owner or building contractor) (date) G' <br /> ZONING ADMINISTRATO ` <br /> ti stn t» �N <br /> O N N N O <br /> Q O U1 O (T O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUA CE <br /> mal td to <br />