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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 /> y O <br /> OWNER �/'1 i' / ���r/(.rTELEPHONE gQ�O/r� //l ��L/ /�!J'/(/y�p/ 0 <br /> MAILINGADDRESS 2�a9 / bkv, '—�Q �I�-fd-�l�jT /�•Ar3r � 0 <br /> �0 r'�u <br /> PROPERTY ADDRESS o2 -Mo <br /> LEGAL DESCRIPTION(see tax receipt) Q w <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ w <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> J�v L Y3AI <br /> STRUCTUREIADDITIONOSE: 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) co <br /> BUILDING CONTRACTOR: NO/cam/T(NTA/DLI�L/Jf�� Jq ZZ <br /> M ml <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. p m <br /> 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 0 �p <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 a <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. t <br /> zj- <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 PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ( N <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. -� f <br /> o � <br /> NOTE: BUILDINGISTRUCTURE 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 <br /> CONDITIONS OF PERMIT: '� { <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. OO <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. This structure to be used as private residential <br /> mo� aoa <br /> 6. om <br /> garage/storage only. Not to be used for human � = d <br /> habitation. o m c y ^ o g 3 <br /> 7. Z c m' o : ' 1 <br /> o <br /> m <br /> I declare that this application (including any acca„ya„y„[g s..VeV V,e/ Vas Veen exanuueu Uy me dlw to me Vest ut my E C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application (including any accompanying schedule)and I further declare that 1 recognize m ` mo <br /> that this information I am provifling will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett rel in on this information I am m E o <br /> providing In this application. I agree to permit county officials charged with adminis i <br /> or <br /> authorized person to h e access to the above descrf remises at any reas b' ' h" <br /> s r n <br /> D <br /> SIGN HERE - <br /> 03 a <br /> (sign tura of ownerlonr b 'Idi g/c�on tor) AY 1e2006 ' <br /> ZONING ADMINISTRATOR \ / I Wln(�•' i <br /> BU NETT COUNTY <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ZONING / ONONNUNO <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE d a <br /> /l 12r � �, <br />