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Burnett County 7410 Co. Rd. K, No. 10;, Siren,WI 54872 Office of Zoning Administrator _ o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ r <br /> V o <br /> pp N <br /> OWNER ,,.1 Ci i I ' txTS I L L T. Qr0 dam'dTELEPFIONE <br /> I4 • 4' Aj s,_ 7 HCl' . /,IS S <br /> MAILINGADDRESS o / _y O <br /> :L2 /1G 1Q •)� � 46,00. SS/O Ci £ <br /> PROPERTY ADDRESS 9,c ;zq 7 FD rA RU IjaAj iL7 Lk ie?T w r SY831� <br /> LEGAL DESCRIPTION(see tax receipt) Z,_ LIXO I - O (p 5-0 O Tl.V P LlQ KO, IV m <br /> f4I <br /> DWELLING/BUILDING 1:10 GARAGE/ACCESSORY STRUCTURE � ADDITION ❑ cn ° <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ C MPING UNIT ❑ SUBDIVISION ❑ I a <br /> STRUCTURE/ADDITION USE: N ° <br /> 0 <br /> (Home/Cabin; Commercial BBroom; <br /> usiness; B Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: S t�C-+7 O,-) iu <br /> v <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN BY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n m I d <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T <br /> T I Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m a <br /> NORTH(N). N C ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. o <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 LANNED AND SHOW AREAS TO BE GRADED OR FILLED. N p <br /> 6. IF SEPARATE PLANS ARE SUBMITTED B AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 N <br /> MUST BE SIGNED AND DATED BY THE O NER. o <br /> o o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS DUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITION z LISTED BELOW. ° 1 <br /> CONDITIONS OF PERMIT: <br /> I c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT S� <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 RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER / <br /> SETBACK AREA. <br /> 5. <br /> 'this structure to be used as private residential <br /> z vravavv <br /> 6. Garage/storage only. Not to be used for human 2 3 a m � a �, z <br /> habitation. z N o 3 <br /> 7. ° -n� ; <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �c ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of io ° vi <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> v <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have ccess to the above described premises at any reasonable time for the purpose of inspection. (D o <br /> CD <br /> m <br /> SIGN HERE <br /> (signature of owner lldi+g contr tor) (date) n <br /> ZONING ADMINISTRATOR I . . <br /> G fA fA EA EA 4 N <br /> (vv N ()i NNOO <br /> (T O N (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />