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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> fn O <br /> C r^� <br /> q d W_ <br /> OWNER (gy m O 3 r d TELEPHONE �S I — 3 1- 39 e 3 0_ %d <br /> MAILING ADDRESS ( A i f l�N S I9 o <br /> 7y� ��_�4 1 N r �p <br /> /\Cf o SS K S7 oa c 1 O <br /> PROPERTY ADDRESS I'�Q '1 L,p St✓ N <br /> ft (� <br /> �-f O \ <br /> LEGAL DESCRIPTION(see tax receipt) Rig Cn (1%1, <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ �� <br /> TYPE OF PERMIT(S): c1 <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> N <br /> STRUCTUREIADDITION USE: S4C mse SL-A A n <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Q <br /> BUILDING CONTRACTOR: �� W <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 /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> -n a Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF r 4�1 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 Q)Q <br /> BUILDINGS, ROADS, LAKE,LOT LINES. 0 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 2 <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. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. cO <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V� O <br /> PERMITTED. 10a <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS. FTC_ ALLOWED WITHIN THE REQUIRED WATER <br /> 5. SETBACK AREA. This structure to be used as private residential <br /> garage/storage only. Not to be used for human X W v iu > o a o m <br /> 6. habitation. m F 3 a o" 0 a m A <br /> p CD C y m o = 3 <br /> Z C N O <br /> 7. o m Z! C M <br /> 1 declare that this application (including an accompanyingscneouie nas oeen examinea o me ana to the Desi of m — O <br /> pp ( 9 Y ) Y Y Vic : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n 0, :5 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c : m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- v <br /> O : 0 <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 JE Q <br /> providing in this application. I agree to permit county officials charged with adminis er m <br /> authorized pars have access t h ove described premises at any reasonabl e o m <br /> T d <br /> US a : <br /> CD <br /> SIGN HERE a <br /> ( ' re of o r building contractor) I Au 2dQg)rl(I(t5 <br /> ZONING ADMINISTRATOR Cw (^' <br /> BURNETT COUN d , , N <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS RMIT SHALL E PIRE ONE YEAR FRO DATE ISSUANC <br /> iKerrn �- �`�-f E e r mai(e --fD �gory rc&y <br />