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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 /> A,tw, 6S1 - 61y o <br /> OWNER &A u i°� `( ,'w, bev l y D ®p�5 TELEPHONE �. .s. ? �- e66 -t4061 <br /> v <br /> d <br /> MAILING ADDRESSC :+y <br /> n y n { '� r <br /> PROPERTYADDRESS �3 7 Z (' f1 e I N {J Y- , s L a 'f ( o W K s i /'to t o <br /> / 1, C .5 M v 3 PIRl <br /> LEGAL DESCRIPTION(see tax receipt)L a.}.3 C SNl V -7 P f C!O C h UCL, (-Ot 14-&V& PRT L.o f- <br /> 1 CD <br /> 2 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ Cl) <br /> TYPE OF PERMIT(S): i <br /> FILLING/GRADING ❑ CAMPING UNIT /❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: N c( <br /> (Home/Cabin; Commercial Business;Bedroom, Deck;etc.) U <br /> S'e f F <br /> BUILDING CONTRACTOR: w <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> -A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n G <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n a A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). 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. I o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I <br /> BUILDINGS, ROADS, LAKE, LOT LINES. SB <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 0 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 0 �1y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z d <br /> CONDITIONS OF PERMIT: 0 <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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. This structure to be used as private residential <br /> s. garage/storage only. Not to be used for human <br /> 6. habitation. m 3= 0 o a m m <br /> 2 o.oO � <br /> CD c <br /> N o 3 <br /> 7. Z <br /> P �I .'0 <br /> m <br /> I declare that this application pncmamg dny dUGVn,tIY„y„ly as uavmc� ,IYi Y��.. ...... , ...v and to the best of my G) - p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d v, e <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem c, 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 Con of urnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged TZ i in nces or other <br /> authorized person to have access to the above described premises at 1 o e f inspection. m m o <br /> 'J <br /> M <br /> SIGN HERE t n L 02 n <br /> (signature of owner or building contractor) G r <br /> Ulm <br /> '� <br /> ZONING ADMINISTRATOR �J 1m'l ,r,NETT _ _ (� <br /> J 77((�� r J S (/J UN N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRE6N�NG a <br />