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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N O <br /> N <br /> C <br /> fD <br /> nn / O <br /> OWNER "- ,o k�eA / Q A joa- TELEPHONE 7lS �(�; S' �Z L3o d <br /> MAILINGADDRESS 1(2 (U-A*y-TIS Sj)OO✓lf-✓ a)L 64(0V1 � <br /> PROPERTYADDRESS <br /> Stat ¢f�o�reiw.r7 <br /> LEGAL DESCRIPTION(see tax receipt) Z _Zq Z_4tp-jy-2yt-(?44A4- <br /> 051700�L C <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ADDITION �/V CO 0 <br /> TYPE OF PERMIT(S): cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> /� N <br /> STRUCTURE/ADDITIONUSE: mLfG Ky.ID �yGCV"4 c <br /> (Home/Cabin; C011mercial Business;Bedroom; Deck;etc.) (n <br /> w <br /> BUILDING CONTRACTOR: 4; 1) d <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> Ci <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a d <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y 0 <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. P <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, CONTRA T R, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ) v f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI M ° <br /> NEEDED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITISSUANCE. C0 <br /> ��'VF� � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 2ON"Aid VIII y v I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. d <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> --S 7-r) This structure to be used as private residential <br /> r > oao -0 <br /> 6. garage/storage only. Not to be used for human 0 3 n x a <br /> habitation. 'D-0 <br /> D c No <br /> y = 3 <br /> 7. Z rn ' : _ � 1 <br /> o .n'2 <br /> M <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my G 2 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o 2in <br /> a ^ : c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ro O mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C: m <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access t9 the above described premises at any reasonable time for the purpose of inspection. m o <br /> SIGN HERE <br /> (signatur wn ror uildin ractor) (date) <br /> n <br /> ) <br /> ZONING ADMINISTRATOR & A � <br /> VV (V\ (TONfT00 <br /> TO NSHIP PERMITS MAY BE REQUIREDA,79`/A :; Q qQ& A- <br /> �3V07 way 118 37 4 <br />