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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> o <br /> OWNER Y .� ( e-t c rsO r-\ TELEPHONE -1(.O S 9( - 10 JA O <br /> /� <br /> L� O <br /> MAILINGADDRFSS a o3 C�t t5-E'er sw\ W4y 1 Ir t dl�y �y 55 _32 <br /> 0 <br /> m <br /> Q `t � o <br /> PROPERTY ADDRESS (J e) 0 Q 0V ,\S \N�C,4(— ) SSl-e r WZ <br /> - Cun.pvter ff `� <br /> LEGAL DESCRIPTION(see tax receipt) �6rtck Goyarr.n\tnE Lv15 a I -yU-\(� COa043 �tci$600 <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ADDITION ❑ 1 <br /> TYPE OF PERMIT(S): c J <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: 5 e V -ib n C¢,* `W? 0 <br /> (Home/Cabin; Commercial Business, Bedroom; Deck; etc.) c <br /> 2. <br /> J <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O - <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T <br /> -n 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C O <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 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. ��?n� :�: O <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 �r 3 Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. +. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° W <br /> NEEDED. �J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Q <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 RETAININr,WAI I S FTC At I nWFn WITHIN THE RF0HIRFD WATER <br /> 5. SETBACK AREA. This structure to be used as Private residential <br /> garage/storage only. Not to be used for human X m d r > o a o m <br /> 6. habitation. mF a n m aCD <br /> a oC:0W = <br /> 7. o mNTID <br /> - _ : T <br /> I declare that this application (including an accompanyingschedule has peen examinea n me and to the nes[ of m - cn 4 O <br /> ( 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 J C m <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize (� <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- D in <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 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized pe rso to have access to the above described premises at any reasonable r i ° a <br /> m <br /> D i <br /> L m : a : <br /> SIGN HERE G Aid a <br /> (s' net a of owner ding contractor) (date) 0 <br /> ZONING ADMINISTRATOR <br /> MAR <br /> / 1 <br /> L V 'IWC" O N CT W W N O <br /> Lf-S-oN W-834 olra OWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY <br /> MIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAINNING <br /> fng,%1 -A +o U, San <br />