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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N 0 <br /> N <br /> C <br /> I �n-+I N <br /> OWNER O rh gs h-��1 l c� TELEPHONE o <br /> MAILINGADDRESS 7669 9 �dti,�i 7 t V` 0C✓,61 r-X 5- y913 D <br /> r m <br /> PROPERTYADDRESS <br /> PIC��e t, <br /> LEGAL DESCRIPTION(see tax receipt) O c <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 5d- ADDITION ❑ <br /> Ll <br /> TYPE OF PERMIT(S): it <br /> FILLING/GR DING E] CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: �le-- A cry+ o (� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) co O <br /> BUILDING CONTRACTOR: le- 2. <br /> CD �. <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Yz X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn <br /> NORTH(N). ti S 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 Ll Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. ISI E <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 O <br /> .�I <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'o f i <br /> v � <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: <br /> A' I <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. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETt-'kllk''`A/A' ' c cTr w i nxACFn INITHw THF RFOLIIRED WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> habitation. CD co d° a M a f m <br /> 6. m x3 �aC)0 CD <br /> �m ct° " o -' 3 <br /> Z <br /> c u o <br /> I declare that this application (including an accompanyingschedule has been exammea o me anu cu me nest of m — ur7. <br /> D <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 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 c : : my <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 o m <br /> authorized person to hav ccess to the above describ prises at any reasonable time for the purpose of inspection. m o <br /> m <br /> Q ID <br /> m Di <br /> SIGN HERE <br /> (p n <br /> (slMatuurre of owherIor building contractor) (date) 0 <br /> ZONING ADMINISTRATOR <br /> 4 �EA EA fA EA�N <br /> OO PO M W W NO <br /> TOWNSHIP PERMITS MAY BE REQUIRED O 01 O u, U1 01 O <br /> THIS RMIT S ALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �rn� �7tc�a�u� 8-�a-�S <br />