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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> 513 <br /> � (� <br /> OWNER ./\ >'C/� rd QJy D r 4 K TELEPHONE/�5/- ?7y 7 73 Y o <br /> y / d <br /> MAILING ADDRESS lPn, .�S• •� O <br /> { <br /> PROPERTY ADDRESS 9176 (V 4n h D4 n 6 ery N AzT S' y k3 n � <br /> LEGAL DESCRIPTION(see tax receipt)S Pe / Gr / <br /> DWELLINGIBUILDING ❑ GARAGEIACCESSORY STRUCTURE ® ADDITION <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> // �ol� N <br /> STRUCTURE/ADDITION USE: NOn�/ he Ty�E [u,.ao 401,r), me <br /> (Home/Cabin; Comm ial Business; Bedroom;; Deck; etc.) <br /> (0I\J <br /> 2. <br /> BUILDING CONTRACTOR: CP /S C40zZ 'TYU (! //O'? 9 <br /> 1 <br /> m � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 'r 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> A y <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) o. <br /> r <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)ANP INDICATE <br /> C _. O <br /> NORTH(N). rn 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 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> S. 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 <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. o p 1 ) <br /> CONDITIONS OF PERMIT: <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. <br /> This structure to be used as private residential M m d d 0 o a o m <br /> 6. ara a/stora a only. Not to be used for human m F 3 a2 x a a z <br /> 8 B g Y o 0'9 <br /> habitation. Z = y o ' <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my ; '^I A <br /> PP ( 9 Y 1 Y c : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of f m p <br /> a Er <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m = mm <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- in <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am0 . <br /> providing in this application. 1 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 /> m D <br /> SIGN HERE /1 �Yl/a%g�tr <br /> (aignature of owner or ullding contractor) (date) o <br /> - *A [ . <br /> ZONING ADMINISTRATOR V IIM <br /> ��yqa_�� ONUWWNO <br /> O U t O (n N 0 <br /> �Oq ✓ TOWNSHIP PERMITS MAY BE REQUIRED <br /> �7S S19 THP PERMIT SHALL EXPIRE ONE YEAR FROM DATE QF ISSUANCE <br /> fL°fmi W-1.eb('ff IY�3 ltd Ez� 6'dT QraffJ �y to/ds/os <br />