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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 /> N <br /> tl <br /> C <br /> QWNER Y t f S-C-2,e 140 TELEPHONE <br /> n / <br /> MAILINGADDRESS f /�� ca 1'� 4 J-e X)Z Ko GG.Ij -5161 RAZ <br /> n SS,9o(, I <br /> PROPERTYADDRESS !1 L/� � Road S'p&M0p / 02 <br /> Qj <br /> `siy/�� G� �/S- �L� 3 `/ � <br /> LEGAL DESCRIPTION(see tax receipt © cn <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE,, ADDITION ❑ Sin �� 8 Cr <br /> TYPE OF PERMIT(S): �.3YU� ' <br /> v <br /> FILLING/GRADING ❑ CAMPING/UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: �(}/Q r OL r �B A�t x T D 0 <br /> /((Home/Cabi Commercial Business;Bedroom;Deck;etc.) c <br /> BUILDING CONTRACTOR: T ^T� C_ F oZ f� a.n f 4'1 f <br /> qffg- Sibitj= 4d;5c 8,V0 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPIV. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m -' <br /> . H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 O n <br /> -n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <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. I o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO rr ,, 11 <br /> BUILDINGS,ROADS, LAKE,LOT LINES. V� �! <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BEG D OR FILLED. I N SZJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUIL THE PLANS � 4 <br /> MUST BE SIGNED AND DATED BY THE OWNER. t o f 1 <br /> O 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSI>� VERIFICATION MAY BE HEN o p\ <br /> NEEDED. JAN 7 � N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. A r M Z <br /> CONDITIONS OF PERMIT: BURN <br /> TETT COUNTY , <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERNIY/N0, d <br /> ISSUANCE. rd 4"" n `(A) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. " C�- <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLYCM <br /> /y 3 Ay lam, <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER © <br /> SETBACK AREA. r_ r� f r 4R <br /> s. 177 — Ke, This structure to be used as private residential Y� S <br /> t 6M OrDpDO -0 <br /> 6. garage/storage only. Not to be used for human p �S� +� 3 a M a W <br /> 7 habitation �Sn� / Z y o " <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my (( �� ,` A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of W' m v+ C <br /> PP (including Yaccompanying ) g �' C D 0 : .� <br /> all information contained in this application mcludin an schedule and I further declare that I recognize C o . my <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to isCD <br /> - <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 oG) <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m o : <br /> / 2503 <br /> SIGN HERE a <br /> (signature of o r building contract ) (date) <br /> (J� <br /> ZONING ADMINISTRATOR ` <br /> a3Sgg AJ <br /> N(T N N O O <br /> (TO (T(TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED AW Lu- <br />