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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 /> y O <br /> y <br /> OWNER I �YTR c I� �- o r�; 1 K��1��—/�� TELEPHONE <br /> 1 <br /> (DMAILING ADDRESS l h 1 F Sn Lnj r a�5 /76)l�J�) eJ 60l 5`10 1(a <br /> ( 0 m <br /> PROPERTY ADDRESS o �lV <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) Y �,T L1 'To 8c)r1.pj� Lu "f I-o l I G �l m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ cn ° }, <br /> TYPE OF PERMIT(S): a �I <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ L`J <br /> STRUCTURE/ADDITION USE: l:G V 0 S' <br /> ome/Cabin; Commercial Business; Bedroom; Deck; etc.) m —T) <br /> �+ 2. <br /> BUILDING CONTRACTOR: I o rah L(I}PA 13u F Q %F✓C) Y C i <br /> m � <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. 0 <br /> 0 y <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE, 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). W <br /> � <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. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O Q' <br /> BUILDINGS, ROADS, LAKE, LOT LINES. * lzJ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. p® N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 7� <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 0 r <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Fno <br /> O <br /> NEEDED. p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1 <br /> CONDITIONS OF PERMIT: (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W o <br /> ISSUANCE. Q> 0 <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 RFOUIRFn WATER <br /> s. SETBACK AREA. This structure to be used as private residential <br /> garage/storage only. Not to be used for human X m 0 r> o CD a o M <br /> 6. habitation. m �x <br /> Oa 2 Ox a <br /> 0 co C y to O 3 <br /> 7. Z C y N O <br /> O <br /> O N -n <br /> _ o, ; m <br /> I declare that this application (including an accompanyingscnebule nas been exammea o me ana to the best of m p <br /> ( 9 Y 1 Y Y G) C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m mt7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am ` m o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other w <br /> authorized pe n to have access to thp above described premises at any reasonabl e I 1 n. <br /> m ° n <br /> r <br /> m ai <br /> v+ a <br /> SIGN HERE r. <br /> (�6n)Iiture of o r Uruilding contractor) I L4 (date) o <br /> ZONING ADMINISTRATOR MAR <br /> C �b9EAfAER�N <br /> O N CP W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY N <br /> THIS PERMIT SHALL EXPIRE ONE Y AR FROPDATEOF_ISSURI NG <br /> rryk I IK 0 � O,T' I n-K <br /> -I- 1 v n , Loa-k hY` S-Y _C <br />