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Burnett County 7410 Co.Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administratorm o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> 0 <br /> w � <br /> OWNER TELEPHONE w �. OC1 <br /> 1 r - � O <br /> MAILING ADDRESS ,Z_3y I (A aLx>o— ��t�� N`M 5 Z O SS <br /> 0 <br /> PROPERTY ADDRESS 2.t4zes ��Lr�� ZU� �� WQ1r�s4��V4 X,./It,C, <br /> 16 %C— ti�l4 /s -?-1 495 <br /> LEGAL DESCRIPTION(see tax receipt) rn <br /> tt �i <br /> DWELLING/BUILDING InoGARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ \�aJ ("c� 5 V) <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION El <` <br /> 4 rtl! <br /> STRUCTURE/ADDITION USE: 4-f 7SAM-4 0 <br /> (Home/Cabin;Commercial Busin ss; edroom; Deck;e .) W <br /> m <br /> �+ <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR Gi_ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p W <br /> 31 vqi <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o e <br /> r o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). lC/1 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF = c <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 C�y <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c i <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 E <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> UQ <br /> NEEDED. "» I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 yj <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT N <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 � ���o a� � <br /> 6. garage/storage only. Not to be used for human : g a m 0 n <br /> habitation. m c Ay o 3 <br /> wm0E �m � <br /> 7. oZ E 21 i E m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m _y' `• C <br /> PP (� 9 Y ) Y Y � i C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of j 1,; 'r-, i Fn <br /> a^° : m 3D <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m � i o i m <br /> that this information I am providing will be relied upon by the County of B �!1�5�Q in in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the C 1 BllrheS th)� Information 1 am <br /> providing in this application. I agree to permit county officials charg i c i irCes or other o <br /> � J$ h� o <br /> authorized n to have acces t the above described premises at n reasons-ble`tF�e pomp onspection. o <br /> m i m <br /> SIGN HERE Q t� L 2 6 Z d d' i n <br /> (al a urs ofbuilding contractor) (ow r r <br /> ��JJ��PP V V i i <br /> ZONING ADMINISTRATOR ✓'l�h^ BURNETT COUNTY <br /> ZONING -7sc,-b-ti7e N Cn N O g <br /> - �j ,p ono cno <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> �c,Iy")-c THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />