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Burnett County 7410 Co. Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> ^' r <br /> �— o <br /> m <br /> OWNER Geu r y>- %f\ae-,e rno r-\ TELEPHONE 61 Z-3 Z 1 -6-7 7 3 w_ <br /> MAILING ADDRESS_3�`yrj SC7 i fC 1Q W�l t���Qr Lgke I�4J� 5�J 1 �D o Z <br /> PROPERTY ADDRESS I�y1 �11er�reer, Pc1�1111DIpoDner ,W= 5q- \L>j i ~ <br /> We ki of N W )� 5ecVjc3�114 *ToW.'AS vp 39 Jnr l',, <br /> LEGAL DESCRIPTION(see tax receipt) nILAWe cou S� ppm <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ o <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADINGI❑ CAMPING UNIT ElE]�\ SUBDIVISION <br /> STRUCTURE/ADDITION USE: fleq N <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) � <br /> (} m <br /> BUILDING CONTRACTOR: P 'C n I � Lumbey n <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> a1 H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T Z r <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n w jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <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. `L <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS V <br /> MUST BE SIGNED AND DATED BY THE OWNER. v F A4�' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC/A ��u1Y(B� w <br /> NEEDED. ,r- <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J�C �0 1 <br /> CONDITIONS OF PERMIT: <br /> Q�� U <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERkIfl�RNFr.ISSUANCE. r, J J1J <br /> 3. NO GRADING OR SHIORELAND ALTERATIONS ARE A2. REMOVAL OR CUTTNG OF TREES AND ILLOWED UNLESS S EC F CALRIS RESTRICTED ALONG YLINE. ZONINGUNry \ <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 3) O r>0 > 0 ;R <br /> 6. garage/storage only. Not to be used for human 9. a m a <br /> C 0 <br /> � habitation. Z m, 'W' w o i , <br /> P m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m$ E G <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 information 1 am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other V m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m , o <br /> m m t <br /> SIGN HERE <br /> T (signa�of owner or building contractor) (date) Lij <br /> a <br /> ZONING ADMINISTRATOR <br /> 1r � � <br /> a� 0 <br /> - 01041 <br /> I ' �6 CIOWNSHIP PERMITS MAY BE REQUIRED /�� <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE �) <br />