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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> CID 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> y o xJ <br /> N <br /> C C b <br /> OWNER -- �'' �S�- �31Y w a _:ITELEPHONE <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS `l e a <br /> LEGAL DESCRIPTION(see tax receipt)sayI f^l.. �- I- �S/17 m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ I v I r o <br /> 0 <br /> TYPE OF PERMIT(S): f r^ n in <br /> FILLING/GRADING ❑ CAMPING U IT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITIONOSE: Rj <br /> � <br /> c ,/� (Home/ abin;Commercial Business;Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: J h e " ' l CSC YI Pol42 <br /> C <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81k X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> M c C L <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p Cl) <br /> m a <br /> ?� O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> t7 w jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m D -O <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 DISTAH CES TO <br /> BUILDINGS,ROADS, LAKE, LOT LINES. I Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BED NE WHEN Z L)E g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG S C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFIC <br /> 4. NO STPERMIRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE R UI 6W%yErt <br /> SETBACK AREA. <br /> 5. S� 1a bL Af )a a�' /o;4- T brmi1R N <br /> lUery `.�`� gURN OIJ TY CID d m m aF m <br /> 6• This structure to be used as private residential ZONING <br /> g 3 a m ; a m. m <br /> 7. <br /> garage/storage only. Not to be used for human No <br /> (00 <br /> habitation. o 1'< m <br /> I declare that this application mcludin an ac om an in schedule has been examined b me and to t)a best of m co D <br /> PP ( 9 P Y 9 ) Y Y <br /> knowledge and belief it is true,correct and om lete. I acknowledge that I am responsible for the detail an accuracy of m n '• in C <br /> CL Ln M <br /> all information contained in his application(incl ding any accompanying schedule)and I further declare th t I recognize m $ : o : m <br /> that this information I am r viding will be lie upon by the County of Burnett Wisconsin in determining hether to is- ' `� E E t7 <br /> sue a permit. I further a c t all liability wh h ay be a result of the County of Burnett relying on this inf rmation I am ro <br /> providing in this applic i . 1 agree to per county officials charged with administering county ordins ces or other <br /> authorized person to he access to the abqifel described pwilrilses at any reaqq!)Able time for the purpose of inspection. w W <br /> T <br /> SIGN HERE <br /> 9 : <br /> (a natu of owns b g contractor) (date) ` i n <br /> ZONING ADMINISTRA <br /> Hi fA, fA�N <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N o 0 <br /> Ut O N O O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE Z Z314 Z/U <br />