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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> CD APPLICATION FOR LAND USE PERMITS 3. <br /> N 0 O^ <br /> ,�r�jA'' 1/ C 1 <br /> I I 1 V� 2 09 <br /> OWNER 1 e s to t �� TELEPHONE \ V?? <br /> ff ``�� / Yid' - lll'��� A� , ) /� �-'�'` N o f <br /> HOME ADDRESS �I 0(0 a4 t /V U) /V et l� IJ/I (BI W I f INS ���� v <br /> EMERGENCY/FIRE NUMBER — �30/�� !,%3 ROADNAMEag2)9'k6WZ/;e <br /> LEGAL DESCRIPTION(see tax receipt) I '"� –� I U) <br /> ©aLg1S0 -Da-66o y�.5-13 -I&A1 ,'-lyk , CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE.ISI ADDITION ❑ PRIVY ❑ O (n 0 <br /> TYPE OF PERMIT(S): V1 it <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ _n <br /> STRUCTURE/ADDITION USE: <br /> (6 < <br /> (Home/Cabin;/Com iall Business; Bedroom; Deck;etc.) cn <br /> BUILDING CONTRACTOR:11�t 4i4wl /' Dat hpgg1� Grr. & l��ywa �t AIJ �c <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. InO <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C m (\ n <br /> NORTH(N). y a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> 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. 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. 01\) `2 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. p N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS Q9 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr ° A <br /> NEEDED. �I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z , <br /> CONDITIONS OF PERMIT: o <br /> t <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human ;a v v o -0 <br /> 6. habitation. $ < w3 a C m <br /> (D X a:. <br /> a : m c m . o 3 <br /> Z : w � <br /> .m: m <br /> 1 declare that this application (including any awumpanyu,g scneauie/ nas peen exammea oy me ano to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofC. <br /> m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ? m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (gyp <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 J <br /> providing in this application. I agree to permit county officials charged with admii 'n r er m <br /> authorized person t ve acc ss he above described premises at any reasons 1 i r r I -n <br /> m : <br /> CD <br /> SIGN HERE i'/V Ae44 G 0 t <br /> ( nat re of owner r building contractor) f, (d <br /> DU <br /> ZONING ADMINISTRATORfn <br /> BURNETTCOUNTYr&'-o� U1o�01oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING 0 0 0 0 0 0 <br /> 0000000 <br /> 01a\ e -1'0 (00F46Ljnd ecere4j,6,,,1 fp,,R.S <br />