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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. ; <br /> r <br /> 90o <br /> A C JD <br /> (1 (D <br /> OWNER '� ^�(� TELEPHONE o rn V <br /> A �-- m <br /> MAILINGADDRESS a-��9� ��� CirC'�� t ,.or K ';r <br /> a�a <br /> `� r m <br /> r 1 ° <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) C� <br /> r I o�� v �� 0�1R l" (D <br /> I� to <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE�I ADDITION 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 2: <br /> STRUCTURE/ADDITION USE: <br /> r�c�r o <br /> (Home/CabiV Commercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR:--V�\(L4e, of\7T-� uLr"t \of\ ' I1\G s Uszk)`4aA 2 � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> CD <br /> r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> n _ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). Ca <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 11` <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 0 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN =r o �} <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z G <br /> 0 <br /> CONDITIONS OF PERMIT: _ <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �- <br /> ISSUANCE. �G' ✓� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 9,J O <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. This structure to be used as private residential <br /> e. garage/storage only. Not to be used for human <br /> habitation. `D m v ° 0 o a o m <br /> 6 . <br /> '0 0 m C y �' o 3 <br /> 7. Z cinmo 719 <br /> P M <br /> _ U, : m <br /> I declare that this application (inciumny dny a�� ,,,ro.,,,..d ___._, _ the best of my ' c 2 (' c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of J : w' a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize O m c ' I m <br /> CD <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 ' a0 ' o <br /> providing in this application. I agree to permit county officials charged with administerin count ord'n he : o <br /> authorized person to have access to the above described premises at any reasons I e i i n. m <br /> -n a <br /> �' D <br /> SIGN HERE C�2 � � <br /> l l �; <br /> (signature of owner or building contractor) (date) i <br /> �� <br /> ZONING ADMINISTRATOR ;J I m ( NOV L <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURN77ETTING COUNTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSL7 UE - <br /> Wkj�,l" -OYD TiUL'004ritchon <br />