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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> � o <br /> N <br /> Qz <br /> OWNER ��} V. \ Q IC1ISSCTELEPHONE a ��? <br /> �O� SOyI i�Sl-`) SLi- 2&0 I �( <br /> MAILING ADDRESS `,q S S�( 1Jt 1 11 L Qd 1 Ut �0.�1X-n )l)n G s ' `�\ <br /> 11 Jy 0k N � <br /> PROPERTY ADDRESS lj 710 W I SLI 9 <br /> LEGAL DESCRIPTION(see tax receipt) G OJt i at 3,+y I r <br /> C1�,1�jS �yJ�l �� �G n� l b CSYny• l o r, ( 1- <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ 1)S3 U) <br /> TYPE OF PERMIT(S): C <br /> a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONT. <br /> ❑ a <br /> STRUCTURE/ADDITION USE: ��((J► /(� X1 y <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> C m <br /> BUILDING CONTRACTOR: I�J �l/ � 2. <br /> -U <br /> d <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR E ~ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O <br /> m (� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p a V' <br /> -n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n -b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m fl 3 <br /> 9i 0 <br /> CENTERLINE OF ROAD,(C) BUILDING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. t o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO t' <br /> BUILDINGS, ROADS, LAKE, LOT LINES. / Oa <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N t <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 2 w <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 D --i W <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o o U <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o W <br /> CONDITIONS OF PERMIT- <br /> 1. <br /> ERMIT: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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RFTAININr_%A/AI I c FTr Al I f1\A/pn WITWIAI THF DFrll IIDFrI%A/ATPD <br /> SETBACK AREA. This structure to be used as Private residential <br /> 5. garage/storage only. Not to be used for human <br /> 6. <br /> habitation. �° d � a m <br /> 3 X '0 � <br /> a =m <br /> 7. Z C N O O O <br /> o : -n m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m C <br /> PP ( 9 Y ► Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n n " <br /> all information contained in this application (including any accompanying schedule)and I further declare that I 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- (D <br /> (� 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 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. <br /> -n n <br /> CD . <br /> SIGN HERE <br /> g ture o ner or building contractor) (date) <br /> W <br /> ZONING ADMINISTRATOR <br /> Q �Vi EA fA EA�N <br /> ON <br /> TOWNSHIP PERMITS MAY BE REQUIRED d O 0 o u n u o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />