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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> to O <br /> a <br /> OWNER LL TELEPHONE <br /> MAILINGADDRESS <br /> PROPERTY ADDRESS ' Hc:..MS <br /> u184Nt V 3 <br /> LEGAL DESCRIPTION(see lax receipt) S 11 74 o R 14 w 13 A <br /> c,raJ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ g��/S� ( ]-j (n o <br /> TYPE OF PERMIT(S): `� � a IZZ: <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �: <br /> / / N <br /> STRUCTURE/ADDITION USE: e <br /> (Home/Cabin; Commercial Business; Se Deck; etc.) (0 � <br /> _ <br /> BUILDING CONTRACTOR: M �Gf I.dI:. C,J4�1 }�..c},•.T C <br /> v <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. O C r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n 1f\- <br /> T oZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m w p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). Cn -j 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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO nn'' <br /> BUILDINGS,ROADS, LAKE, LOT LINES. F� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS ..Q > > <br /> MUST BE SIGNED AND DATED BY THE OWNER. <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. a !� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. V} 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY W <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> s. $/�/ Oral, S P+ --/3 ,s. � T , vo <br /> m�� � oaoM <br /> 6. Tb LV—0^4. This structure to be used as private residential g x 3 a g x a2. a <br /> garage/storage only. Not to be used for human Z N o 0 Z 3 <br /> 7' habitation. ° _ m <br /> I declare that this application (including an accompanyingscheouie nae Dean examineo o me and to the best of m — ^ ' O <br /> PP ( 9 Y 1 Y Y �� � ; C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of [ m a : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c rn <br /> that this Information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is. s <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 d o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized perso to have access to the above described pre 'ses at any reasonable time for the purpose of inspection. <br /> _ T <br /> > : <br /> SIGN HERE <br /> (sig re o owner or b ' i ontrador) (date) (L"/,7�`� � [ <br /> ZONING ADMINISTRATOR <br /> G�fA fA fA f9� N <br /> o N a W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED d o 0 o v, u, v, o <br /> THISP-E � <br /> RMIT SHALL EXPIRE ONE YEAR FROM DA E F ISSU=E �_O(J— <br /> .c�m► - �Jor �b- <br />