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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'n o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O Q <br /> N <br /> OWNER 71/C7`ic/cU 5 . y 6eZrXG6 t3a1v TELEPHONE n <br /> O A <br /> m o` <br /> MAILINGADDRESS At/ /y newm— .GZZY �!U* G/! :3 <br /> ��+ <br /> PROPERTY ADDRESS �o v"t �t>"/Y Y/Y — /C <br /> LEGAL DESCRIPTION(see tax receipt) J m <br /> — — 2 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ `ry rn <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ez)i <br /> STRUCTURE/ADDITION USE: S/ Vrao e bu, I d t r ig <br /> (Ho /Cabin; Commercial B ' ess; Bedroom, Deck, etc.) co <br /> m � n <br /> BUILDING CONTRACTOR: m <br /> � 1v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO m <br /> ;0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 6 � A 3 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m -30 <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. rn p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO "1 <br /> BUILDINGS, ROADS, LAKE,LOT LINES. 6 �` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O o XJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS = <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <br /> w p = <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. Fi (n�` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o W <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT J <br /> ISSUANCE. 1 r <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. W C <br /> 4. NO STRUCTURES, INCLUDING RETAINING;WAI I S FTC AI LOWED 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 /> �1 a) (fir- ➢ ODOR <br /> s. habitation. � 3 a 00 Ox a � <br /> 0 (D C y N 0 <br /> Z C 0 N O _� 1 <br /> �. O N -n m <br /> I declare that this application (including an accompanyingscneame nas ween exammeo o me ano ro me uest of m — c^ ' A <br /> PP ( 9 Y 1 Y Y � E v : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m 0 o <br /> all information contained in this application (including any accompanying schedule)and I further declare that 1 recognize m m <br /> that thi on I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �' m U) C <br /> sue a Oermit. I furl ccept all liability which may be a result of the County of Burnett relying on this information I am w o <br /> providinin this applic 'on. I agree to permit county officials charged with administering county ordinances or other <br /> authorized rson to h e cess taLthe above described premises at any reasonable time for the purpose of inspection. CD <br /> r Q <br /> CD D <br /> C' <br /> SIGN HERE ��� w <br /> (signature wner or building contractor) (date) o <br /> ZONING ADMINISTRATOR <br /> �v+ V1( c_nv <br /> O OPQ WWNO <br /> TOWNSHIP PERMITS MAY BE REQUIRED Q o V <br /> THIS PERMI SHALLPIRE ONE YEAR FROM DAT OF ISSUANCE <br /> J�e�mt+ le-Her P%��e uP by ,CAard( 6e)rgeSOn <br />