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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 /> OWNER � .T =y -!�'I'� �I�f�f.J� 1 C�^C�. � TE <br /> (� Rt <br /> MAILINGADDRESS g'6I � pf�ISJYVIfJ' ��, S�r iWrN �I E <br /> PROPERTYADDRESS <br /> � <br /> 2 ��� J <br /> LEGAL DESCRIPTION(see tax receipt) �� �'�,1� I �rti� b i7U7h d <br /> DWELLING/BUILDING ❑ GARAGE/AE9EseaRT'STRUCTl ADDITION ❑ <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> AA pp r� / N <br /> STRUCTURE/ADDITION USE: rl�-t r�/-t^�� 0 <br /> .�^^ (Home/Cabin; Commercial Business; Bedroom;;; Deck; etc.) j Co <br /> BUILDING CONTRACTOR:S��� l�A"V`-z , <br /> z � <br /> J <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> -iO N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o\ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <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. 9 <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. d <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ii <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS =, o O <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o �i <br /> CONDITIONS OF PERMIT: CC pp ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r v <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �•1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS. ETC..ALLOWED WITHIN THF RFOI IIRFD WATFR <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> A d10W DODO V <br /> 6. habitation. g 3 � g g f m <br /> 0 m C ryj, y 0 3 <br /> 7. Z N O 7 <br /> o N T� m <br /> 1 declare that this application (including an accompanyingscnedwe has Dean examined b me and to the best of m — 2 �^: A <br /> PP ( 9 Y 1 Y Y g9 [ p C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of f m' o . "' <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 I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `� ' <n <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 f o E <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other ,o <br /> authorized person to he ae s to the above describ premises at any reasonable time for the purpose of inspection. . <br /> > i <br /> SIGN HERn <br /> y w a <br /> ( gna re o/o or building contractor) i I( rI ( a (� i <br /> Wi i <br /> ZONING ADMINISTRATOR (( /� (�( <br /> APR62OOG OO NNWWNO <br /> TOWNSHIP PERMITS MAY BE REQUIR O O N O N N N O <br /> THISPERMIT HALL EXPIRE ONE YEAR FFtQM DATE 0 iumn COUNTY <br /> �Pe�mi - � le+-ler and i le of-fV -J-& l Of loom tZONING <br /> rn� 171 1 11 r 1rt 11'R7MI <br />