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Burnett County 7410 Co. Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS <br /> y O <br /> H <br /> OWNER + A,4 rifle &kkm TELEPHONE 657�-���-l�Qa/ w <br /> // � ,/ m <br /> MAILING ADDRESS 5S� u..ghO L4 /W �5rO�4/ f <br /> / r m <br /> 61 <br /> YJ o <br /> PROPERTY ADDRESS <br /> d 30 I <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) 5 30/-Flo/R 17W <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ V) <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CA PING UNIT ❑ SUBDIVISION ❑ <br /> Daft/t h 63�r ae 3 <br /> STRUCTURE/ADDITIONuSE: <br /> (Home/Cabin;Commercial B ess; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. � �� j p y <br /> C �J L O N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) r��� v tc M a <br /> J / '—I o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 jo <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO �y <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. $ Si <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ' n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. V <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 /> 5. garage/storage only. Not to be used for human <br /> 9 �ravavv <br /> habitation. //; /� g 3 M A a* M <br /> 6. D. v (OD <br /> J ,~ ! N1 <br /> 7. <br /> Z w m p o <br /> m <br /> D <br /> I declare that this application(including any accompanying scnauunsj nas ween exa......v.. ..y .,ast of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of R n <br /> f ami <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ci fll <br /> that this information I am providing will be relied upon b the County of Burnett Wisconsin in determining whether to is- <br /> P 9 P Y tY 9 €Lj v <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett rel in on thiVn , am mproviding in this applicati I agree to permit county officials charged with a m i r er o authorized person to ha cess tot above described premises at any reaso 0 ti m o <br /> �j 10 <br /> m i <br /> SIGN HERE 1611W Q <br /> (signalsfe Pf owner or buil Ing contractor) JUL <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNTrY <br /> N o S <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> TH PERMIT SHALL EXPIRE ONE Y A FROM TE OF ISSUANCE ��}vi <br /> rm ef-�e� fnal-led �o [Yrari 8a 9-18-65 <br />