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cJtv COMPOTE SCANNED <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y o � <br /> c <br /> m <br /> a <br /> OWNER �J � TELEPHONE 5-' <br /> J,! m iJ <br /> / m <br /> MAILING ADDRESS Z)(c Lq ICL C if`CS Ri0d l4��ti}C G = r'/� V o <br /> r � <br /> o <br /> PROPERTY ADDRESSoji <br /> LEGAL DESCRIPTION(see tax receipt) ��-�- �, w� I I J m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ rn O <br /> TYPE OF PERMIT(S): I Q ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: �ja Pu.4 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> / v <br /> BUILDING CONTRACTOR: n, <br /> bv� er CA <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR O 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> .� <br /> N (�1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a )[J <br /> -n <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 <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO Im 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF U� Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 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. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N �N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS nn � f"J <br /> MUST BE SIGNED AND DATED BY THE OWNER. �J o <br /> O � rpr <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o V <br /> NEEDED. 2 _ <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 <br /> ISSUANCE. V' <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. l t <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALI S FTC Al I OWFn WITHIN THE RFnI IIRFn WATER <br /> SETBACK AREA. <br /> 5 This structure to be used as private residential <br /> garage/storage only. Not to be used for human X ca 0 r > o a 0 -o <br /> 6. habitation. LD F 3 a ; a C <br /> =m C (n 0 o <br /> Z c n o <br /> 7. o m -n< <br /> = cn m <br /> I declare that this application (including any accompanying scneaule) nas been examined by me and to the best of my �j169 <br /> 4 O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m o cn <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- : `D cn 0 <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 v o <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other v <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. `D <br /> -n a : <br /> CD m CL <br /> SIGN HERE, - Z e� cn a <br /> (s' na ure of own r or building contractor) (date) 0 : <br /> ZONING ADMINISTRATOR U E 3 <br /> n <br /> ONUn W NO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 4- o Cn O Cn Cn O <br /> THIS PERMIT SHALL EXPIRE O JE YEAR FROM DATEOF ISSUANC5 1/ Imo, ����� <br /> 1 I9 i'—,z.L 4- I�Y_ZP� �!.4 Y n w1 if L. �/1 r-I-1 1 /A.-� 4 ,1A 1 �� <br />