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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator CD- o° o <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> N W <br /> OWNER TELEPHONES/T 6S —q —o w <br /> ,, �/ }� O <br /> MAILING ADDRESS /�/ (n_r�n� A�� X111 Y oi r CD <br /> o <br /> PROPERTY ADDRESS I#/ COO, 4 <br /> 1. <br /> LEGAL DESCRIPTION(see tax receipt) S. Ia - 3 o . 4 W L,f- a'A,( V18' PaQ63 <br /> ( N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Pe ADDITION ❑ © � ° <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> / L/8 H <br /> STRUCTURE/ADDITION USE: C ely R f-P 3 LP X ° <br /> 1rr D(Home/Cabin;Commercial Business; Bedroom; Deck;etc.) (nBUILDING CONTRACTOR: n (d A U I�I pd c J <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p y UJ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 CD < \Y <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m w �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C 75 c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 30L Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO r, <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BfRIFICATION <br /> OR FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILETC.,THE PLANS �. o <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V MA`I PIN <br /> NEEDED. ° <br /> NEEDED. tJ4N <br /> THIS PERMIT S SUBJECT TO ALL CONDITIONS LISTED BELOW. �UR���/ 7 2,94 / o <br /> CONDITIONS p� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P SN 01j/V , W <br /> ISSUANCE. G Q <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. <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 > v n o m <br /> 6. garage/storage only. Not to be used for human g 3 a m x a <br /> CD <br /> v Cy N o <br /> habitation. o y m 79 <br /> 7. . : m <br /> — r»I ` E D <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> ° : v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Vu (CDL ` m rn <br /> rn <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> (D m: <br /> authorized person to have access to the above described rmlses at any reasonable time for the purpose of inspection. m o <br /> CD <br /> SIGN HERE <br /> (s a re f o r building contractor) (date) (�J a i <br /> v 1 i <br /> ZONING ADMINISTRAT R E `: `• `• <br /> loor NNNN` Ik� t') O 0 <br /> MOA <br /> (11 O(!1 CTO O <br /> 3 nj TOWNSHIP PERMITS MAY BE REQUIRED <br /> by4Z ' ��ITHIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />