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Burnett County 7410 Co. Rd. K,No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION �FOR LAND USE PERMITS pq c. <br /> OWNER l I Wim"— BY' �6Y6. t r l(A/s C:t"� TELEPHONE111 <br /> p <br /> MAILING ADDRESS ae �' � �.�–., awl I rnyl_ 5516, 0. <br /> �/ I I m <br /> PROPERTYADDRESS <br /> t <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARACEIACCESSORY STRUCTURE K ADDITION ❑ U In <br /> TYPE OF PERMIT(S): <br /> FILLINGIGRADING El CAMPING UNIT ❑1 SUBDIVISIO�Nnn❑ a <br /> STRUCTURE/ADDITION USE: —Z l e _--. O D'1.� 1 71 1 `�-�'"l�'t KAa-V-t1✓ t ` t ij , �' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> � y <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X it SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> A - N � <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) 0a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. TO <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NS)AND INDICATE m <br /> NORTH Rk m O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> In c <br /> CENTERLINE OF ROAD,(C)BUILDING($)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS o y XJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. 5 sO Q <br /> O o <br /> NOTE: NGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. 4 <br /> NEEDED. r� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. v <br /> CONDITIONS OF PERMIT: 0 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ilST <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS. ETC..ALLOWED WITHIN THE REOUIRFn WATER <br /> 5 SETBACK AREA. This structure to be used as Private residential <br /> garage/storage only. Not to be used for human X m d d > 0 o T <br /> aim <br /> 6- habitation. ai <br /> 0 om C'^ '" o5 <br /> 7. Z m o z <br /> o m <br /> I tledere that this application(Including any accompanying screams, nas been examinee cry me ane to me oast or my m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of v`f pp <br /> all information contained In this application eked upon <br /> any accompanying schedule)and I further declare that 1 recognize rr �� <br /> that this emit. I further <br /> I ac providing will be retied upon by the County of Burnett Wisconsin In g on this <br /> In whether to Is. v� 0' w. <br /> sue i permit. 1 further accept all liability which may baa result of the County of Burnett relying on Ihla informallon I am �' <br /> providing In this application. I agree to permit county officials charged with administerin county ordinances or other m o <br /> G : <br /> authorized person to have access t the above described premises al any reason le lu <br /> a <br /> SIGN HER w <br /> (sigr I tyro o/owner or building contractor, pp r� (e�tge) <br /> ZONING ADMINISTRATOR awy ) C /\ APR L LO096 <br /> w ww <br /> I y3DS � TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY d N N <br /> //THIS PERMIT S�iALEXPIRI E ON�YEARFROOM D T O ISSUAQPING <br /> tml a e N ✓vr"SC , F�-a3-bb <br />