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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o° o <br /> APPLICATION FOR LAND USE PERMITS <br /> fl N o <br /> y �W <br /> C <br /> ��1 6 <br /> TELEPHONE �� —aa a- O <br /> OWNER � S�e�� <br /> m O <br /> MAILINGADDRESS O �p (� / �2 n JS&/L✓t </ W� S4 <br /> o <br /> PROPERTY ADDRESS G oV ,14 j <br /> LEGAL DESCRIPTION(see tax receipt) r m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ c D <br /> TYPE OF PERMIT(S): Cr <br /> a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: 6/92u 9 P X Z <br /> (Home/Cabin; Commercial Business; Bedroom, Deck, etc.) <br /> BUILDING CONTRACTOR: ✓[J/�/ys o/`� �n S 2Lt C T / oi✓ �L t' B <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 w <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O FITJ <br /> A c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> T <br /> M Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2 .SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m _ <br /> rn o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m30 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF t o <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DFO),AND ALL DISTANCES TO i <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 j, o } <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> o <br /> 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: (' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> � ^G <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 REOI11RFn WATFR <br /> SETBACK AREA. This structure to be used as private residential <br /> s. garage/storage only. Not to be used for human X m iv d a D o D o m <br /> n m <br /> habT. itation. 3 R ; ; a z <br /> 6. -o <br /> 0 <br /> Z c m C N O <br /> rn O ••� <br /> O N7. TK M <br /> I declare that this application (including any accompanying scneouie) nas been examined by me ana to the best of my a c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a ^ A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- J <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information lam <br /> o <br /> . <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other j <br /> authorized person to have access to the above described premises at any reasona I t c d• - n <br /> m Di <br /> a : <br /> '.,ir� v+ E a <br /> SIGN HERE //ee� <br /> (s' at a of building contractor) ( ate) W: <br /> APR252005 <br /> ZONING ADMINISTRATOR : <br /> . ONMWffl N <br /> 10001 � 001uloTOWNSHIP PERMITS MAY BE REQUIREDBURNETT COUN ` <br /> THIS PERMIT SHALL EXP E ONE YEAR FROM DATE OF ISSUM�G <br /> Lkp b� `rh d nlcs "pre L/-C)(0-05' t� <br />