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Burnett County 7410 Co.Rd. K,No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS . '5- <br /> AeI1 50-,6g3- q-75 R y 0 � o <br /> OWNEROIU TELEPHONE <br /> IG i\'e. � � n 6 o <br /> I11 <br /> MAILINGADDRESS �y �� P45 W , �a -z e I r,,,e [A 5 N 1 1 Z <br /> PROPERTY ADDRESS w <br /> Q � <br /> LEGAL DESCRIPTION(see tax receipt) 4 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ (n <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <: _ <br /> STRUCTURE/ADDITION USE: G[AC Q Q ° 1V <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) /n <br /> 1- �7 I m2. <br /> � <br /> BUILDING CONTRACTOR: � fJ r\� L l P, l <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Yz X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. OT w ` <br /> IZI (/1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C \ 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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. ::E <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N W <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. o 1 <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a C� <br /> NEEDED. a �/,1�) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 1 <br /> CONDITIONS OF PERMIT: �' Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT _F <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 l� <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RFTAININC;WAI I S FTC At I nwFn WITHIN THF RFOtJIRFn WATFR <br /> SETBACK AREA. <br /> 5 This structure to be used as private residential <br /> garage/storage only. Not to be used for human X co C1r r 0 D 0 <br /> M c w d 0 m n F m <br /> 6. habitation. 3a 0 <br /> p <br /> N C <br /> Z c m m ° 1 <br /> 7. o m it`s <br /> _ C, m <br /> I declare that this application Includln an accompanyingscneoule nas peen examinea o me ano to the best of m A <br /> PP ( 9 Y ) Y Y G`) c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n " 50 <br /> PP (including Yaccompanying ) g �` <br /> all information contained in this application Includin an schedule and I further declare that 1 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- 0j: m (n : <br /> 0 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this info n Iam i o <br /> OO <br /> providing in this application. I agree to permit county officials charged with r other <br /> authorized person to have access to the above described premises at any rea a CD <br /> u e tion. m Q <br /> CD <br /> m n <br /> SIGN HERE <br /> (si a re of owne r building contractor) MAY 2 nft ) W: O . <br /> ^ i <br /> ZONING ADMINISTRATOR <br /> BURNETT �'69 60 Q <br /> TOWNSHIP PERMITS MAYBE REQUIRED ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DAIE OF ISS NC <br /> f�'la(fieDI w 14) 1tf-k-r+D 1a (c `��rye Vf6(2 5-ao bs <br />