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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator c) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> o <br /> u. <br /> OWNER C, ARV I `l�LL TELEPHONE G�_S -,�� 3 - cl p <br /> MAILINGADDRESS 2)l71 I L EiLt T ER L JLL& Ro fA-P�b4%op' 'UjM <br /> S f ,r 4 8.51 ?-'7 �(`/ r Z-b O <br /> / r . -110 C � <br /> PROPERTYADDRESS Zf;86(, `JLO f}/Gf/7t�v � <br /> LEGAL DESCRIPTION(see lax receipt) 5ECTI10 N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: S HES U I y5o ' Plt Ua-k o p <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) W <br /> BUILDING CONTRACTOR: I N f"O.SS U f`1 4� <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 A <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> r� 4 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <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 m O <br /> NORTH(N). y 3 <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. <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. 0 <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0, o <br /> MUST BE SIGNED AND DATED BY THE OWNER. to <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q o V.1 <br /> NEEDED. = O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1 <br /> CONDITIONS OF PERMIT: (a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY - <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUnINr,RFTAININ(:WAI IS FTr. Al I C)WFn WITHIN THF RF0t IIRFn WATER <br /> SETBACK AREA. <br /> s. This structure to be used as private residential <br /> T7 a10 � DODO V <br /> 6 garage/storage only. Not to be used for human 3 a 0 0 a <br /> habitation. v o <br /> 7. O AyTK _� X1 <br /> m <br /> I declare that this application Inclualn an accompanyingscneoule nas Dean exammeo b me and to the best of m E^ A <br /> PP 1 9 Y ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of [ [ d <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m 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 ami m o <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have accepV the above described premises at any reasonable time for the purpose of inspection. <br /> CM D i <br /> �/d a : <br /> SIGN HERE � u6 <br /> Ig lure ner or building contractor) (date) 0 <br /> ZONING ADMINISTRATOR d <br /> TOWNSHIP PERMITS MAY BE REQUIRED ' <br /> T PERM T HA L EXPIRE ONE EAR F OM�PPATE OF ISSU CE <br /> y ir,t �Ie pt ch:l bq dawn- /n uS-kGQ.ry fh:ll <br /> —rer-ri <br />