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Burnett County 7410 Co. Rd. K,No. 102, Siren,WI 54872 Office of Zoning Administrator 0 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> o <br /> _ c 9 <br /> m <br /> OWNER t Lr'`A l! k�---'' �.'I� TELEPHONE -, ! [ � �L7 2-7 � <br /> /`n/ o - I <br /> MAILING ADDRESSL� <br /> �o <br /> PROPERTY ADDRESS �" � <br /> LEGAL DESCRIPTION(see tax receipt) 5 C C. <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ �(n ° <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ y: t „ <br /> STRUCTURE/ADDITION USE: n—C�t/l iH(fAe/_ ° W <br /> 0 <br /> (I"Igple/Cabin; Commercial BusineW <br /> Broom; Deck; etc.) � <br /> BUILDING CONTRACTOR: � 'CJ 15 C- 1�'L-o`-C l C''til- 5 t <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T f ^1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p V <br /> .0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n Il r\ <br /> ,n <br /> 'T1 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> CNORTH(N _ O <br /> 3. SHOW D M)ENSIONS 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. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO t C <br /> BUILDINGS, ROADS, LAKE, LOT LINES. _ <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 CJS o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° W <br /> NEEDED. lV^� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 00 i 1 <br /> ISSUANCE. (fJ <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 /> TBACK REA. !� /�I" <br /> 5 fIUa4 (S a lSrv%u�e O�v/ <br /> cmm M 0 Mal m <br /> 6. This structure to be used as private residential 0 F a F a s x <br /> garage/storage only. Not to be used for human z =y o y o 3 <br /> 7' habitation. ° I 2-1 ;U m <br /> w <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of oTD <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m E i m <br /> CD <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 7 <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am I(-�^/ m ° <br /> providing In this application. I agree to permit count officials charged with administering count ordinances or other v <br /> P 9 � PP� 9 P Y 9 9 Y <br /> authorized person toAve access to the above described premises at any reasonallkldtlqn. T a <br /> SIGN HERE <br /> (si at re of <br /> ow�nerbIding contractor) �l (date) 0 <br /> ZONING ADMINISTRATOR NOV i M j i (� <br /> �2 N <br /> TOWNSHIP PERMITS MAYBE REQUIREDB <br /> URNETTCOUNTY ao �oW � � o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSLWONG <br /> /Ya Bed 4v Ed Cb rue( � JI-Da-oL/ <br />