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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning N C itli$,tr � S(�A. #4 D oz <br /> APPLICATION FOR LAND USE PERMITS o UMW 3 <br /> Cn <br /> g(o 7S cn <br /> CD <br /> �©p ERT a V- Pg Yl 11 s' C � y�p <br /> ��EPHONE ►7l � i7��� <br /> OWNER (L <br /> CL <br /> p r <br /> CD <br /> MAILING ADDRESS r 1-/ I S J��/�-1 •-- SPO�WF <br /> A r�/Lam/ O <br /> .Ti l7 lam r m <br /> o <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax�eceipt) Cn <br /> n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ C: ^�- <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> H'❑/� <br /> N <br /> STRUCTURE/ADDITION USE: A I TI ON [y �x�J T�'✓ v y��l� <br /> 0 <br /> D D <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) C <br /> BUILDING CONTRACTOR: 6�a/ v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> c C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) on a <br /> -n 0 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 rn <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 -1ZZ <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. O 0 <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. ry <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS �0 � t <br /> MUST BE SIGNED AND DATED BY THE OWNER. co 0 <br /> v. 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. "- <br /> I <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 C� <br /> ISSUANCE. W C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 0 C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAININr,WAI I S FTC: Al I nWFn WITHIN THE RF()I nPim WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> CD <br /> CW W 0 oaom <br /> 6 habitation. 0 a 50, a <br /> 0 os m CZn <br /> w o 3 <br /> 7. Z c N 0 <br /> 0 m : T' <br /> = cn m <br /> I declare that this application (including an accompanyingscneauie nas been exammed b me and to the best of m • -: O <br /> PP (' 9 Y ) Y Y c -4 : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of @ �" <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize co c m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 m 0 <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other CD <br /> authorized person to have access to the above described premises at any reaso pe ion. a <br /> CD <br /> )b JW <br /> CD <br /> co <br /> SIGN HERE CD a <br /> a re of owner b ding contractor) (date) o <br /> ui <br /> 0 i <br /> ZONING ADMINISTRATOR OCT 2 3, 2004 <br /> 2���$ �FQd�fi v� _� 9 7 O N cn W W N O <br /> `"' aocnocncncno <br /> ((00a, ad 1p_6- TOWNSHIP PERMITS MAYBE REQUIREBURNE� COUNTY <br /> recEK-0j THIS PER T SHALL EXPIRE ONE YEAR FROM DATE OF ISSZQN*G <br /> Se-fhar_LC <br />