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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 O —�Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> F <br /> N <br /> fn ^ ^ <br /> t d Y <br /> OWNER � Rio " TELEPHONE 636 <br /> MAILING ADDRESS 1 ra:5 1 � -S+ ^�a i� � �" l�Rr <br /> CD <br /> PROPERTYADDRESS <br /> ?1-9q9 d. /t Q" A 'S 1 <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) S��/ / /1 'y N /V co <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ <br /> co o' <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a "'n <br /> STRUCTURE/ADDITION USE: cu 0.A AA11 1Jan o <br /> (Ho a/Cabin; Commercial Business; Bedroom; Deck;etc.) C C <br /> d <br /> BUILDING CONTRACTOR: 1� nnc'h'ttiC kOn � <br /> -4 <br /> T <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. -n <br /> O — <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OCDe <br /> -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Zn A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C n <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 v <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 O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. p <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N JU <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 <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 WHENO <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J <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. ,� j/ _ This structure to be used as private residential <br /> 177 _ garage/story a only. CD W D O D o v <br /> 6. g y. Not to be used for human CD 3 a ; F a C z <br /> habitation. <br /> CD <br /> 7. Z inMWo � � 1 <br /> T� M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of (� D n in C <br /> - 1 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �' C <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 IIU,1, m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other W ° <br /> authorized person to have access the above described premises at any reasonable time for the purpose of inspection. fD : C <br /> n 0 : <br /> r m <br /> SIGN HERE r f' i U 114-03 °CD <br /> � <br /> a : <br /> (sign lure of owner or buil ng contractor) (date) <br /> ZONING ADMINISTRATOR <br /> Q, <br /> f/i fA df fA N <br /> V N N N N 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED �J1;t- L <br /> o N O (T (TOO <br />