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Burnett County 7410 Co.Rd. K,No.102,Siren,W154872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> N O <br /> /� 1, / &S-VI C <br /> OWNER LI K) lA E/ 12N W O G r�CN Q LC E�JELEPHONE CGt3�-� I <br /> — <br /> CQ <br /> MAILING ADDRESS <br /> 19k-0 4Aye.eh/e_ AUE_ _&n ci e o b741, S"Sb lb �'r <br /> CD <br /> PROPERTY ADDRESS 9 )� U eU /�1� 6GL� 7 \ T� <br /> LEGAL DESCRIPTION(see tax receipt) � e� ed �� �_ /b I m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE LT'-ADDITION ❑ (n <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < 0 <br /> STRUCTURE/ADDITIONUSE: QCiP U ° 77, <br /> Coiome/Cabin;Commercial Business; Bedroom; Deck;etc.)) (n <br /> BUILDING CONTRACTOR�Wf}J)dN /1 1,_5 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> .tl N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T n <br /> .n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m j0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH-(N). to 3 <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. P <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. 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. E <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN H $ <br /> 3. <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: G <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. 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. C t>� 10 <br /> lam,/lrC.!�/ 611 C W r D v D v m <br /> s. <br /> O _ This structure to be used as private residential 0 N cL S a m <br /> m am � � � M <br /> garage/storage only. Not to be used for human � C c H o <br /> 7. @ <br /> habitation. o (OD,� ; <br /> =W: m <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my 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 M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D 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- ; G) <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am V m <br /> providing in this application. I agree to permit county officials charge qRordinances or other m <br /> E <br /> authorized person to have access to the above described premises at piqn4 I m i pose of inspection. m o <br /> SIGN HERE <br /> CL : <br /> (signature of ovVner or bulldi ontrTtor) date) <br /> U <br /> MN <br /> 0 <br /> ZONING ADMINISTRATO <br /> BURNETT COUNTY � N <br /> L" o Moo <br /> TOWNSHIP PERMITS MAY BE REQUIREMNING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE1 <br />