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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> ur o <br /> ID <br /> N 1 <br /> OWNER ° G� �C&VL I TELEPHONECe <br /> MAILING ADDRESS U 01C If G) otl e, Pt1 1M�, <br /> 0 m <br /> PROPERTYADDRESS a g (�l �) )� /� 1�O�Ya (( 0 X u/ 1 <br /> LEGAL DESCRIPTION(see tax receipt)LI <br /> PIA- 1 <br /> i 1� , I (4 :) / o';J (.�"(`V 9 $ ► 3 f�l jU / I1 Il u' "17 11�a ID <br /> DWELLING/BUILDING T❑1 GARAGE/ACCESSORY ADDITION 1:1Phi I X o V �Q k--N) (Do <br /> TYPE OF PERMIT(S): 9J v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑C-7 <br /> n <br /> STRUCTURE/ADDITION USE: 1 �� QC) Y �!D L— & O <br /> _ ° <br /> (Home/Cabin; mmercial Business;Bedroo , ck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: f GG L r o <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> y c ' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 4 a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 6 m M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N 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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ( o <br /> 4. SHOW TF E LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDING),ROADS, LAKE, LOT LINES. <br /> 5. INDICATE A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <br /> 6. IF SEPARA*+E PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. �0 0 <br /> o 1 <br /> NOTE: BUILDING)$T13UCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT E DONE WHEN ° <br /> NEEDED. � j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. , , Z I <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P IT <br /> ISSUANCE. �p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORf�LTIVE?�� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALL�J(J V <br /> / <br /> PERMITTED. '7`� A7EN / <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRE <br /> SETBACK A�REA. <br /> 5. kV _ N This structure to be used as private residential N/N��NTy <br /> garage/storage only. Not to be used for human an d 0 o a o m <br /> s. habitation. �7(lDO\' 0y1c g. 3 a ; ; a <br /> lT &V'� 1301'I/UI11 N N y <br /> Z N N ° ..l <br /> 7. Side lot I ne_'--1031 fi2vn Cel T <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my t, C) <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of 'u n v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m m o v <br /> that this informrapfic <br /> providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. cept all liability which may be a result of the County of Burnett relying on this information I am a <br /> providing in hiion. I agree to permit county officials charged with administering county ordinances or otherauthorized erse access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> CD <br /> l m m <br /> SIGN HERze�� <br /> E <br /> n : <br /> (signature of owner r building cont c nr) (date) <br /> ZONING ADMINISTRATOR ,c I (�/ I I I��� <br /> • O N Uri N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED J / <br /> -� lot L(`vvs — ((ed 11 ' <br />