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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'D o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. UJ <br /> _ r <br /> N <br /> 0 <br /> OWNER41 ✓ 011//C ''4 �1//'/O�S TELEPHONE 6:5-1-Z 7D" .SI <br /> m �- <br /> MAILING ADDRESS <br /> PROPERTYADDRESS /J7 Z <br /> LEGAL DESCRIPTION(see tax receipt))4/ z C Sh1 Z (/Gf//704 Z32- <br /> DWELLING/BUILDING <br /> 3ZDWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE A ADDITION (/> 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING [ICAMPING UNIT ❑ SUBDIVISION El <br /> /- a (^ <br /> STRUCTURE/ADDITION USE: 4'-.4a G F_ Zy�( �6 �/ F��T 0 <br /> Home/Cabin; Commercial Businest; Bedroom; Deck; etc.) rn <br /> -,� -s rte_ <br /> BUILDING CONTRACTOR: ILWC441vi <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n (^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). .` o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m (� t 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Y <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 Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. nl o \ <br /> V/ p 4Z <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ^» o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: Q <br /> 1 <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. 11P .� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. (n Q <br /> 4. NO STRUCTURES, INCLUDING RETAININr,WAI IR FTC At I OWFn WITHIN THE REQUIRED WATER ��11 <br /> 5. SETBACK AREA. This structure to be used as private residential <br /> garage/storage only. Not to be used for human X m O r- n o r o v <br /> 0c d d 00 m a f m <br /> 6. habitation. m a F 3 cm x a m z <br /> C) m CN y o 3 <br /> Z cym0 <br /> 7. o m M <br /> = v, : : m <br /> I declare that this application (including any accompanying scneauie) nas peen examinee Dy me ana to cue nest of my cj C) <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <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- (D to <br /> L7 Cn : <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 other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ° n <br /> -n--- f D <br /> CD a : <br /> SIGN HERE <br /> ( ' na ure of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR v 1 i <br /> O �EA fA to EA�N <br /> ao � o � (n010 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THISERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAN E <br /> R(ATt4- --le, -kr ()-)oj jet tz) k)ot-4f ark 3u Ices 6-3-es <br />