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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 O Z <br /> APPLICATION FOR LAND USE PERMITS 3° p � <br /> r N <br /> N 0 <br /> OWNER � n TELEPHONE nJ <br /> 1L <br /> 6 03 V`P mo W 2Q / oL�c Road <br /> �2�S/ei(G(�� �f3 v O <br /> MAILING ADDRESS a7n <br /> r � <br /> PROPERTYADDRESSo <br /> 17R/u e, , ,(0a n&,,oe,-4 GvT <br /> LEGAL DESCRIPTION(see tax receipt) <br /> Lbf oac, rn <br /> i-�8��]JJI�aPlrll�,�m�1L�Iti.rn7� 1��,6/p 4ya�[k//ew to r m � <br /> DWELLING/BUILDING F1GARAGEAC EC SSORY STRUCTURE lal ADDITION ❑ cn 0 <br /> TYPE OF PERMIT(S): c D <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a f` <br /> STRUCTURE/ADDITION USE: QC1JU)oR, / ULQ CIQ. O p 1 <br /> U <br /> (Home/Cabin; C mercial Business, Bedroom; Deck; etc.) rn <br /> 1 v <br /> BUILDING CONTRACTOR: 2�P S c�l�ae l d, v > <br /> �- <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR I �s <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. OTT ^ In <br /> IV 41 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 'D <br /> NORTH(N). C O <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 fj Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. A o <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 IC <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 o p <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> aNOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. �b <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z -'/ <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �- ((�^ <br /> ISSUANCE. of <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <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 X co d iu > o a 0 m <br /> 6 .garage/storage only. Not to be used for human 3 <br /> f <br /> habitation. z y m o7. N ° 3 <br /> 9 m -n < m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m — 9i O <br /> PP ( 9 Y ) Y Y G) C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ; �_ • c" <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- rf: : . ; to : O <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 o <br /> providing in this application. I agree to permit county officials charged with,aor ther D <br /> authorized person to have access to the above described premises at any rea 1 or r s <br /> -n a : <br /> m � D <br /> SIGN HERE �oZ or�{�Gt� G a <br /> (sig a of owner uilding contractor) DEC 2LW4) `n . 0 <br /> ZONING ADMINISTRATOR ` '• <br /> BURNETT COUNTY d 69(0'A 64 4`'N <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> .P�64ta tf byS�e✓G/1�Sfa/ChnS}ensen �a ao oy <br />