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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 z <br /> APPLICATION FOR LAND USE PERMITS <br /> " r <br /> y O <br /> N <br /> C <br /> —�� <br /> d <br /> OWNER Th T� ��C� TELEPHONE <br /> MAILING ADQ <br /> DRESS �6� ���t J�C� yl (I �� �, �p �f tv <br /> r � <br /> PROPERTYADDRESS RuSk 261—ez7 � �jr pn x-77 Ile- /CCyo <br /> FY r� \II <br /> LEGAL DESCRIPTION(see tax receipt) 12-51'—Al Al �GG �C�s (/-j P//f CI-4 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> in <br /> STRUCTURE/ADDITION USE: <br /> (56ra�e. kS4-a <br /> (Home/Cabin, mmercial Business; Bedroom; Deck; etc.) rn (� <br /> BUILDING CONTRACTOR: (JU��/l (��S7 GT/D 1 eFJ&— ZO <br /> D 3 <br /> 6 3s—8 sa6 Jf�„ 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O N �� <br /> � v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> T Q Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y .A n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO RI �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. <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 V ° <br /> MUST BE SIGNED AND DATED BY THE OWNER. f t <br /> 0 f„ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN = ° W <br /> NEEDED. ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: (C� <br /> Cl 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY pQ 0 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING o-TAn.nnln XArA1 I c CT(` Al I r Atr:n WITHIN THF RPni IIRFn WATFR <br /> SETBACK AREA. This structure to be used as private residential <br /> 5, garage/storage only. Not to be used for human <br /> X OOOr DODO 10 <br /> 6 habitation. 0 0 3 a 0 0 CL A <br /> �� C: 0 . 3 <br /> 2� z <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — ^ O <br /> PP (� 9 Y ) Y Y �� C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m �_ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- U) <br /> sue a permit. 1 further accept all liability which ma be a result of the County of Burnett relying on this information I am v o <br /> providing in this application. I agree perm' cou ty officials charged with administering county ordinances or other <br /> authorized person/0 have acces t t_Wabovo des ribed premises at any reasons t io ° 'o <br /> m > : <br /> SIGN HERE <br /> ( ml re of own or ilding contractor) (date) I W i <br /> ZONING ADMINISTRATOR <br /> UY " 2W5 <br /> 1 Vi[fl EA fA� N <br /> BURNETT COUNTY C N J J N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMITrSHALI_EXPIRE ONE YEAR FRO ATE OF IS U 11 <br /> ft it 0 w Htd )e+� +0Vx(04') Con uC-1701N <br />