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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 = <br /> i r <br /> N o lJ0 <br /> OWNER �, . }nl�� TELEPHONE �SZ�UUZ -�74 LI n <br /> MAILINGADDRESS �I(p Z� ���s7 L✓Cf O <br /> PROPERTYADDRESS 2SZ�Z 'J�n` <br /> - _ &YAl/LSo.(/ /IOA/J <br /> LEGAL DESCRIPTION(see tax receipt) <br /> [[771 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> TYPE OF PERMIT(S): � Q ' 4 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n moi) <br /> STRUCTURE/ADDITION USE: J (� Pbt�-I �_ D X G� 6 - 0 p <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ( <br /> BUILDING CONTRACTOR: <br /> m <br /> v <br /> o <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -r! <br /> 3 r <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 T <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 1D. R <br /> NORTH(N). <br /> n <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 <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 a <br /> BUILDINGS,ROADS, LAKE, LOT LINES. SU F <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. r�O <br /> 96 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ; Q 6 <br /> NEEDED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o O <br /> CONDITIONS OF PERMIT: p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. b <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 RFOUIRFD WATFR <br /> SETBACK AREA. This structure to be used as private residential <br /> 5' garage/storage only. Not to be used for human <br /> Tl C OMDOa <br /> 6 0 ;habitation. d 0 g M <br /> g f m <br /> x3ar� x .. � a <br /> v p m C N ." o 53 <br /> 7. Z o m o <br /> O N T� m <br /> I declare that this application (including any accompanying scnedwe) nes peen examined Dy me and to the nest of my A <br /> n_ 62 ` v : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 1I1v1lV' i'u n I N [ <br /> all Information contained in this application (including any accompanying schedule)and I further declare that I recognize W m I m <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 <br /> providing in this applicatlo I agree to permi county officials charged with administering county ordinances or other m' m <br /> authorized person access to thea de !bed premises at any reasonable time for the purpose of inspection. ` m <br /> m : <br /> r n : <br /> m D : <br /> 7 m a : <br /> SIGN HERE � ' > <br /> (signs uret owner r building contractor) (date)(tlate) 0[ <br /> ZONING ADMINISTRATOR �./ r m FL(A.01" J <br /> ocNii�in ' o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALLXP RE ONE YEP% FR M DATe OF IS VANCE <br /> R-rmi+-d-7e. ;Dt( YUP bL/ haor) kbyae- a-al�F-D� <br /> I <br />