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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS P <br /> Z--3q- 472,_ -L432 <br /> 4A yN-aiTELEPHONE -I1OOWNER 3- q�Z 3 70 n <br /> '0/ <br /> MAILING ADDRESSZ.�.>`i7 '�'{ - � 5 ? O <br /> J � <br /> L d f 6/ L-er{ SuxVPx t (o nL9j 4067 1o( ZI QQ 1431 �� o m <br /> PROPERTY ADDRESS r� -t- w Gov Lei. T .rP r{'zcf v� ! T 38n) air ) `+! _ <br /> y, r?Y' <br /> LEGAL DESCRIPTION(see tax receipt) N IS, <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> ❑ Q o (" <br /> TYPE OF PERMIT(S): ( n c 9"' <br /> 1:1vI <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> dor ute -� c b©� +-r-&, erg v 2y o <br /> STRUCTURE/ADDITION USE: o <br /> /n <br /> � (Home/Cabin; Commer lal Business; Bedroom; Deck; etc.) O <br /> BUILDING CONTRACTOR: Se (T. ? n <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY IN OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) 0 � <br /> -n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o A <br /> 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 Z <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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. p _ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �✓ IN �.. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS I 0 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2. <br /> o QN) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT —. Q <br /> ISSUANCE. <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 U, l <br /> PERMITTED. ryJ <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 /> garage/storage only. Not to be used for human A m Or D O D 0 -0 <br /> 6. habitation. x 3 n m x a , A <br /> 7. Z cum o m <br /> _ P m I T <br /> I declare that this application (including m, v y,,,y bu„wuulwl nab Dwell eaarnmeu Dy me anD w me us <br /> of my - »' ` in[ D <br /> y wwvm au <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n N ! 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- <br /> O : z : <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 i i : m : o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. ' [ <br /> SIGN HERE ( I OJ m a <br /> (signature of owner b lding contractor) (d te) o <br /> ] . <br /> ZONING ADMINISTRATOR I M r) <br /> G in i»in <br /> W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o 0, N M <br /> THIS PERMIT SHALLEXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> PI-rmil- 4 "P bl , Avrol Ke-lby /a-►3-OS <br />