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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54E 72 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3UT 0. <br /> work- -1�3- 553 -54 Al <br /> OWNER j i LLr A-A CUq_%STql TELEPHONE <br /> M <br /> MAILING ADDRESS cjckoS 5 5TA v6 N 1cto,)T LlM N SS 414 Z- <br /> A4LAPW ll <br /> PROPERTY ADDRESS L p'`' uS EF-u-*.w k%uEr- <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESS RY STRUCTURE ADDITION El / rn <br /> TYPE OF PERMIT(S): (�'1 c <br /> FILLING/GRADING ElCAMPING UNIT ❑ SUBDIVISION El7 v—;�j S. <br /> S. <br /> STRUCTURE/ADDITIONUSE: rEEL e&aF e.+ 'Parrs - C <br /> (Home/Cabin; Com nercial Business;Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: Sils m <br /> 42 -{ <br /> a <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 S 1EET OF PAPER. ANY INCOMPLETE OR m3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> XI N Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIE ) On <br /> 25 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHO N OR DRAWN TO SCALE. n !t A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDI GS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BU LDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m \ <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT 10 THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO t-I <br /> BUILDINGS, ROADS, LAKE, LOT LINES.5. INDICATE IF A WALKOUT BASEMENT IS PLANNED ANDS W AREAS TO BE GRADED OR FILLED. <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. <br /> v � C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKEO SO AN ONSITE VERIFICATION MAYBE DONE WHEN -"- o <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW P <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENT 3 WITHIN 60 DAYS OF PERMIT i <br /> ISSUANCE. IW: <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RE STRICTED ALONG SHORELINE. 5u <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWE D UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,At LOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. ( , <br /> 5. �+ <br /> This structure to be used as privai a residential X d Iu>o a O v <br /> 6. garage/storage only. Not to be used for human g B a g Ox a m <br /> 'O a1 Cy 0 0 3 <br /> 7. <br /> habitation. z y o _+ <br /> o -n <br /> m <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my G7 c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C ? o •'. m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ) <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 O <br /> m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other pp o <br /> N . <br /> authorized person to have access to the above described m N <br /> premises es at any reasonable time for the purpose of inspection. -no <br /> SIGN HERE �.J� 1 C 9 /2-S- &Z— 4A <br /> n : <br /> (signature owner ,uildding contrac or) (date) <br /> ZONING ADMINISTRATOR v 1/Y1Pr II ' <br /> E»cn <br /> EA EA Efl EH� N <br /> N u t N N O O <br /> NOU [TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />