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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o o <br /> 5-0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r kik <br /> N O <br /> y <br /> C <br /> (D C <br /> a� �� 71 --'SW6 33K a <br /> OWNER TELEPHONE O <br /> (/ C d <br /> MAILINGADDRESS 7 J9 me, left lel y��1 &-z kry /c,),-,E V <br /> P � - r m <br /> o <br /> PROPERTY ADDRESS 7 L1,2 n f/ S�'�r-/ T FC �('t/ ��,,_� �1J `✓ <br /> LEGAL DESCRIPTION(see tax receipt) ! `--SM V. I-7 P. M <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ V7 <br /> TYPE OF PERMIT(S): iT ' <br /> FILLING/GRADINGCAMPING UNIT L-1SUBDIVISION ❑ a <br /> / < <br /> STRUCTURE/ADDITION USE: 4), 0 -� <br /> (Ho e/Cabin; Commercial Business; Bedroom; Deck; etc.)i W <br /> ^ v <br /> BUILDING CONTRACTOR: zdP// w <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T <br /> -n ' Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). y C 1 0 <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 <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. n o I <br /> o I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> S <br /> Lu <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> I ( <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> XW n r D 0 D 0 M <br /> s. habitation. 0 F 3 a 0 x a <br /> = <D C q y C 3 <br /> Z C N ry O ' <br /> 7. O (D �n� . m <br /> N <br /> I declare that this application (including af9:...y awvn Nouyn y a ncuwcf naa u....Icnannnw vy n.c mm ru u c oast Of my p <br /> G) c : v C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m' 0 N <br /> all information contained in this application(including any accompanying schedule)and I 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- ° (n <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 w o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access t he above described premises at any reasonable time for the purpose of inspection. m <br /> -nCD . a : <br /> CD > : <br /> SIGN HERE <br /> (signa�f ow or building contractor) (date) o <br /> ZONING ADMINISTRATORin <br /> \ ) 1 a <br /> �oN) aW � o <br /> TOWNSHIP PERMITS MAYBE REQUIRED p�1S1 — <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />