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Burnett County 7410 Co.Rd.K,No.102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> r ^ <br /> N <br /> C <br /> CL <br /> OWNERe J Q TELEPHONE <br /> v -4> <br /> w <br /> MAILING ADDRESS <br /> SSG <br /> r � <br /> 0 <br /> PROPERTY ADDRESS <br /> S(-, _3 .� Yc) tiI? 1 `� io �rscc �. <br /> LEGAL DESCRIPTION(see tax receipt) rn <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE LA ADDITION ❑ (n o <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUED IV SION ❑ <br /> N <br /> STRUCTURE/ADDITIONUSE: Yfor F o <br /> (Home/Cabin;Commercialbusiness; Bedroom; Deck; etc.) w <br /> BUILDING CONTRACTOR: J G(/ - C �� ) — — <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/h X 11 SHEET OF PAPER. ANY INCOMPLETE OR T S. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 " �4 <br /> M N \\ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF —IZZ,Z <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 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS _ 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. i/ 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC 1011 N <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ll�gY z <br /> CONDITIONS OF PERMIT: evAN g /� <br /> 1 SSVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ; I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O/��N^ �/�� W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY MLLTT <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential =1 iu r > 0 a 0 m <br /> 6. 0 3 a (D M ;w � <br /> garage/storage only. Not to be used for human c y y o <br /> 7. habitation. Z !t ° <br /> ° m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to he best of m ^� : 0 <br /> PP ( 9 Y ) Y Y G, c : : : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m , : v,: <br /> a - u, : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m : o mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 1: <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this in ormation I am w <br /> providing in this application. I agree to permit count officials charged with administering count ordinances or other <br /> P 9 PP 9 P Y 9 9 Y E (a : Cn <br /> authorized person to have access to the above described premises at any reasonable time for the purposem <br /> of inspection. m o <br /> SD <br /> ,� �7_- 5-IQ _G m i m i <br /> SIGN HERE b L(/ <br /> (sl g t e of owns or building contractor) (dat ) <br /> ZONING ADMINISTRATOR <br /> /' R C) 4 EA(n• fA 0 N <br /> 0 4� f`J1 N (1, N O O <br /> (TO NOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 ��� <br /> S '��LI THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE S <br />