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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator -0 Q Z <br /> APPLICATION FOR LAND USE PERMITS . �, , <br /> 1 _ t Ct _ //__ N <br /> OWNER C r c- CD <br /> Ya�JOMLSlyneQ TELEPHONE —74e-j—jaq— 14-10 v 0 � o <br /> w_ <br /> /�' <br /> MAILING ADDRESS P b �� 334. �r � j�— w CD <br /> PROPERTY ADDRESS J--t O I "6 S p t r7� 1-0t r1 L '+l� i'ra�'i e- <br /> Y�/ <br /> I? <br /> �K <br /> LEGAL DESCRIPTION(see tax receipt) Lpt l r SM V l?n�1 <br /> DWELLING/BUILDING ❑ RAG CCESFSORY STRUCTURE trJ ADDITION ❑ �" W <br /> TYPE OF PERMIT(S): ?� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ^ <br /> STRUCTURE/ADDITION USE: QPi X oZ !S 0 <br /> ome/Cabin;Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR I C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> � y JJ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T a <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. i7 6 � 70 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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 S� <br /> BUILDINGS,ROADS, LAKE,LOT LINES. ) <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FI -10 <br /> LLED. Iv Q/1�I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CO TR AARYR,ETC.,THE PLANS W <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT(J <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: 4 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM� vF�'ISSUANCE. C / I <br /> Uj <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I0N�1�/V+ VNTy J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLYd+J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER (� <br /> SETBACK AREA. <br /> 5 S-11,)) This structure to be used as private residential M 0 r- D 0 D 0 a <br /> 6. garage/storage only. Not to be used for human m P R <br /> habitation. z H W c y D <br /> 7. o i nz i 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. 1 acknowledge that I am responsible for the detail and accuracy of w n E <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeE m$ i M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- <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 w <br /> providing in this application. I agr o permit county officials charged with administering county ordinances or other <br /> authorized per to have ac to remises at any reasonable time for the purpose of inspection. T ? E <br /> io <br /> SIGN HERE <br /> of owne bul ng contractor/ (date) f 1 ,. ' °' i <br /> ` w: i <br /> ZONING ADMINISTRATOR <br /> Abel I Uy TOWNSHIP PERMITS MAY BE REQUIRED o o <br /> 0 THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />