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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 /> o <br /> N <br /> 7/ 6359 <br /> a <br /> OWNER �s�ciK. TELEPHONE �� O <br /> MAILING ADDRESS PC,> 'a-C>,<- 413 5i)o FiCL f(1�.� O <br /> 5�{ 1 <br /> PROPERTY ADDCD <br /> RESS {fes COVNTt.3 V AD <br /> .OC-� C�NU�"/�� "TDI • <br /> 9 5 0 Zi q 0?-H39 /RI L4w AcR65 40.oo . <br /> LEGAL DESCRIPTION(see tax receipt) ,"Z -3� ^�l `O Z ' O 02,00p 9f, 5 tj,, <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ADDITION Ll (n O <br /> TYPE OF PERMIT(S): 1 Q ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. o <br /> i I r / y. <br /> ? <br /> STRUCTURE/ADDITION USE: ?oLf al o <br /> (Home/Cabin; Commercial Business; BedroomD; Deck; etc.) (n <br /> ' c <br /> BUILDING CONTRACTOR: 510naqXII, K- <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLET OR 3 GJ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p m � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o } <br /> -n v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). ( o <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 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. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N n <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS ° <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 <br /> CONDITIONS OF PERMIT: (i' CN <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. d <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q <br /> PERMITTED. !(, <br /> 4. NO STRUCTURES, INCLUDING RETAINING WAI I S FTC At I OWFn WITHIN THF RFOIIIRFD WATER W <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> c M° 0 T a f m <br /> 6 habitation. g F 3 6, 2 <br /> F a , A <br /> .o p m (Zym o 3 <br /> 7. Z I m m o : co q <br /> o m -n : .'0 <br /> _c, [ [ m <br /> I declare that this application (including an accompanying scneduie nas been exammed oy me and to the nest of m 1J <br /> PP (� 9 Y Y 9 ) Y J E G) � „ , c <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of C?: m � <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- - I: m (n : O <br /> O : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m o <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to!Vv!eF.Sjss to thea cribed premises at any reasona i cti n. CD ° 'n <br /> m <br /> N ai <br /> ss a <br /> SIGN HERE 46 <br /> - <br /> (sign of owne r b ilding contractor) (date) �,� 0 <br /> ZONING ADMINISTRATOR MAR 2 8 2005 ; <br /> 3-10-9y Forch/t"*f n /0-9 <br /> OWNSHIP PERMITS MAY BE REQUIREDBURNETTT COUNTY d o Mcg o <br /> THIS PERM1 SHALL EXPIRE ONE YEAR FROM DATE OF ISSU7ANW4G O l C <br /> IlA I " � i <br /> uft � QU" <br />