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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _0 ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r- <br /> n O <br /> C <br /> OWNER joe��/S TELEPHONE <br /> V m <br /> MAILING ADDRESS 2� �OSpf' /y�1 O ' <br /> wd�thl �✓/, Sy�93 ' <br /> PROPERTY ADDRESS � <br /> r It *r /7 <br /> LEGAL DESCRIPTION(see tax receipt) 'Y22-2 19j—/bd VO&A ; ? .?9_l I '*4 tb 6.004 4!r, 2 pC <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE X ADDITION <br /> ❑ o <br /> TYPE OF PERMIT(S): l <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTUREIADDITION USE: /E�'/ OPS C0erI4'411�71W FX6 ,f 70` <br /> (Home/Cabin; CoiVmercial Business; Bedroom; Deck;etc.) <br /> w <br /> BUILDING CONTRACTOR: <br /> m <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. -n Q <br /> rTl H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) On <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m y <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m �l <br /> NORTH(N). o <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. CT <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 PLANS0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. r� o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN n o <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <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 REQUIRED WATER <br /> SETBACK AREA. 41ti <br /> 6. / s � � This structure to be used as private residential 71 o r D 0 > 0 a <br /> garage/storage only. Not to be used for human @ 3 'a ; x a a � <br /> 6 .habitation. a m c y o , 3 <br /> 7. Z w m O <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n d, c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 17 <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 m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. �" U) <br /> � ������ Q m o <br /> ' <br /> SIGN HERE A-4— 1'T ' /�'� d� d' <br /> (signature of ow r building contr or)r (date) <br /> ZONING ADMINISTRATORC <br /> 7jW� fz�l LN0' Ln (T OO <br /> l <br /> TOWNSHIP PERMITS MAY BE REQUIR�,�dlk t(/� ��FIC <br />