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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator _U c c <br /> APPLICATION FOR LAND USE PERMITS . ' ^ <br /> rTDO <br /> ''�'' <br /> ((V ) <br /> N O 1 1 01 <br /> C <br /> nAt' <br /> OWNER Q f)V ) 0 4-L l i'V 0i'lae O L ) y TELEPHONE CC 'P-70b SST m <br /> 1�1 w �^ <br /> MAILING ADDRESS 4-73 G E ti 13 0bQl `(_A VV In No o 5�0) 3 <br /> ` m <br /> PROPERTY ADDRESS g n� rV J ~ <br /> 1 <br /> 3a �t Q. /(ogot > esM Vl9 P13 C2) <br /> S <br /> LEGAL DESCRIPTION(see tax receipt) �r f N l/a �l SF �yq W ©>C I/e (o U-) Aver <br /> r � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 0 ADDITION ❑ rn 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING//GRADING ❑ ElCAMPING UNIT SUBDIVISION <br /> 'i A ❑ a Q <br /> STRUCTUREIADDITION USE: 1R A G C ��/X `Y0/ 0 <br /> n ii \ <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) d <br /> BUILDING CONTRACTOR: C�C I S-4 c <br /> 3 <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T '3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o - <br /> -n v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m :332. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <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 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. <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 t <br /> MUST BE SIGNED AND DATED BY THE OWNER. f t <br /> v � tW° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o C, <br /> CONDITIONS OF PERMIT: W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 9.3 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 41 Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5' This structure to be used as private residential <br /> CD oOimcDimafm <br /> 6, garage/storage only. Not to be used for human C 3 a 2 Z a m n <br /> m w - M <br /> habitation. z H m o 0 =1 <br /> 7. <br /> ° '—'` : m <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m `. . <br /> PP ( 9 Y ) Y Y ; ; : 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 m o my <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 m <br /> providing in this application. I agree to permit county officials charged pjltl� .r isantes or other o <br /> � <br /> m : : <br /> authorized person to have access to the above described premises at a ie0(f= of inspection. m o: <br /> SIGN HERE d' n <br /> (Pilo a of owner or building contract ) APR ( tt) <br /> ZONING ADMINISTRATOR _ y <br /> URNETT COUNTYd'` �'N <br /> 1 N U N O O <br /> {1'd Gnt/ TOWNSHIP PERMITS MAY BE R QUIR ((�� ��((;; c 0 4 v o 0 <br /> ,-a ct THIS PERMIT SHALL EXPIRE ONE YEAR FROM DA�F'INANCE <br />