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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 CID. <br /> r <br /> OWNER TELEPHONE 6S/6V 1-ookO 1 <br /> MAILING ADDRESS ' l�(� SFjHt � S� ��� ;tb✓ 5Z7/'3 m <br /> k <br /> m <br /> /� yy n " `r <br /> PROPERTY ADDRESS a-7 ?o( /�0ya.4t-, evA-i 1 Gl "sfa. WIT ��/ 3 o <br /> 0 r, 'D <br /> LEGAL DESCRIPTION(see tax receipt) LoT-3 C S M Vq p 2.3b (j v 6otw 60 3 f buy-f a f.� oQ � <br /> Lrs t + 3 cSAi 1,%4 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 14 ADDITION ❑ o <br /> TYPE OFPERMIT(S): �: <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> /2� 5 <br /> STRUCTURE/ADDITION USE: �Y � CtA, It7d o 5� <br /> /y (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: TQ k CL**Attu — &/W d- Ax'$raAAc_ 6A"je, (w..A d rn27` <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n C- <br /> ?t 0 • 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). <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. d <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N QJ <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. m o <br /> O n <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN rn o <br /> NEEDED. M <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z I <br /> CONDITIONS OF PERMIT: <br /> C)o <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. <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. She f�Q�l2a•=•Q� vJ< <br /> 6 This structure to be used as private residential M d ab>0 a v M <br /> garage/storage only. Not to be used for human a. 3 FL m x L1 m 7D <br /> 'O m C y N O j 3 <br /> 7. habitation. Z a i o ' a <br /> o j G . 70 <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my (� Co' 6m) <br /> �J'': 'O <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 I recognize �C m i E G <br /> that this information I am providing will be relied upon by the Coun i Ining whether to Is- Q <br /> sue a permit. I further accept all liability which may be a result o n I I is Information 1 am <br /> providing in this application. 1 agree to permit county officials i t� dinances or other <br /> authorized person to have access to the above described premia a any reasonable time for the u ose of Inspection. m <br /> I�� m o <br /> rj Lllt!'F <br /> SIGN HERE 5 .O <br /> (s a ure of W building contract©) (data) <br /> ZONING ADMINISTRATOR URNETT COUNTY !UJ (1 E <br /> ZONING /cOq3-R- O o $ ra <br /> T01 <br /> OWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE �1 <br />