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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -IM o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> UT o <br /> OWNER -to W LL TELEPHONE <br /> d <br /> �y { .� (D <br /> MAILING ADDRESS fJ5091 MQ�Q0.f c�\. . [A:%-te e-prLQke . Mn ')5kka <br /> r � <br /> 0 <br /> PROPERTYADDRESS 8).83 Pa+'!( webste1- w1. 5g8ct3 <br /> w <br /> LEGAL DESCRIPTION(see tax receipt) O 3'0 Lk 4 .15— O 2- CD <br /> (� <br /> ((VVII 2 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ rn <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> ` y < <br /> STRUCTURE/ADDITION USE: 5�O Cal e.Aw o c k S ho a o <br /> (Home/Cabin; Commercial usiness; Bedroom; De ;etc.) cn ' <br /> BUILDING CONTRACTOR: m <br /> v <br /> m <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. In <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 Wo <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <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 Z <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 /> S. 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. o Do� <br /> 1 v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VEFZ1q ��ff3F{DE WHEN <br /> NEEDED. <br /> V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: quG+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OR 17 7�� <br /> 2. R <br /> EM OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI E I I COU/V7. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY /MING ' <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 ; v 1 v n v v <br /> 6' garage/storage only. Not to be used for human 3 a a <br /> CD oC <br /> 7. habitation. Z CD ; o <br /> Z -n� z <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of W o F» <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize CD 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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m s <br /> - o <br /> (D m <br /> SIGN HERE h O <br /> CL <br /> (sl ture of owner or building contractor) ( ate) <br /> ZONING ADMINISTRATOR � <br /> � EAr) 0N <br /> N) N N <br /> N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> /-S—j 5� GUa y <br />