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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. = <br /> r <br /> rn o <br /> r m <br /> OWNER Lay TELEPHONE7/ <br /> o Q� <br /> T1 m r <br /> a / PQ�n7�0 r a D,^, o <br /> MAILING ADDRESS <br /> r � <br /> PROPERTY ADDRESS D(((� 6Ur✓ i . SyBa'0 - VO7 o <br /> lLot /� C6-5/1v// V <br /> LEGAL DESCRIPTION(see tax receipt)acty' T-7 13 104v/7 4/0 &4/rnj+E' /7._ CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ to 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> N <br /> STRUCTURE/ADDITION USE: f7�orrre a(�X a 8 0 <br /> (Home/Cabin; Commercial Business; Bedroom, Deck; etc.) <br /> BUILDING CONTRACTOR: 4iCD <br /> m <br /> C <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> TI 3 <br /> 63 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <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 <br /> M <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 03o <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. U) N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTR011, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> ' I 0 1 <br /> c F <br /> J -- ' a , s— 7 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT�N MAY ��tJ - �a 0 <br /> NEEDED. 40(f), <br /> t/�n J = a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. % 40(f) <br /> 19 Z <br /> CONDITIONS OF PERMIT: 7 / P [� <br /> BURN ?� ;, ,s <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �7T co <br /> ISSUANCE. ZQ�/ liv�y <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. (J CJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5 This structure to be used as private residential <br /> garage/storage only. Not to be used for human Xa) d r > o n o <br /> 6. zaaon. 3a v <br /> 0 N C y y 0 3 <br /> 7. Z C 41 N O O t0 <br /> O N T� m <br /> I declare that this a licati — �' '• <br /> pp ___.. . .y ,,,r and to the best of my (n: ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m �_ c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m cn <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am d o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. mo <br /> T <br /> N <br /> SIGN HERE ! <br /> i �p y D <br /> e t» a <br /> (sssignature of own g or building contractor) (�ate o <br /> ZONING ADMINISTRATOR <br /> I,4n`�N <br /> TOWNSHIP PERMITS MAY BE REQUIREDONO W W N O <br /> i-:;- aM-�' -2:22- <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE r <br />