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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator ci z <br /> APPLICATION FOR LAND USE PERMITS . <br /> OWNER <br /> �-t C TELEPHONE f Gy-- C-b6n <br /> r/re 71 & -33Lq -7 <br /> MAILING ADDRESS I /1 pI Z3 N - 8-04 den WT- 6 0 � <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) &C;+Oh 5544 f q I I v I t L(p(p 1 \ <br /> C <br /> f� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> ❑ % o <br /> TYPE OFPERMIT(S): W a' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o, <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) C <br /> C \ I <br /> BUILDING CONTRACTOR: C2�0'1 2?. <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O m <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. �z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 03 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 0 <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),Am DISTANCES TO w <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRI�bEQ �} '` <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,SCONTwRCT f N <br /> 0� TC.�}[ IRI�dNS' <br /> MUST BE SIGNED AND DATED BY THE OWNER. yy.•J�JJ � F 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VER'41CATIONINAY `j# WHE i ' <br /> NEEDED. <br /> (f r/1 W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. RN��(;® C z W <br /> CONDITIONS OF PERMIT: ZdNINO UNT-Y o ). <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. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER (� <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential M W m a <br /> s. garage/storage only. g 3 a g <br /> y. Not to be used for human 00 c y y o <br /> 7. habitation. <br /> 0 `0 <br /> o T M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Uj E <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m' 69 C <br /> PP (including Yaccompanying ) g "� ai E V 70 <br /> all information contained in this application Includin an schedule and I further declare that I re nize m o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other `: m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. 0 , <br /> CD <br /> 0 U) <br /> m o <br /> SIGN HERE /2I� m m <br /> us m <br /> (signature of,owner or building contractor) (date) a <br /> ZONING ADMINISTRATOR I rYl <br /> in is ifl to 62 i» <br /> TOWNSHIP PERMITS MAY BE REQUIRED � 1@ c o m m o o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAN;Ey60 /4' <br /> J�G(C rYlCu l�d� S�euld�f <br /> q-3-63 <br />