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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> - r <br /> N O <br /> y <br /> MINER pav d �- Pe�b�e Pei e�s o n TELEPHONE (a la--390.- 70007 0 <br /> MAILING ADDRESS d I q`/ 10 3 r `� nye /V. A a�le 6 rte/✓ S-S 73��j <br /> r' <br /> (' n n / o <br /> PROPERTY ADDRESS I '� A 7 R 9 j e F4.5 R <br /> LEGAL DESCRIPTION see tax receipt) �y I lv <br /> ( p) Sr-r- 24 T 40N - IR i4w LQ �i � � � S <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 9 ADDITION ❑ (n � (� <br /> TYPE OF PERMIT(S): < <a <br /> FILLING/G//RADING ❑ CAMPING UNIT ❑ ElSUBDIVISION <br /> a <br /> STRUCTURE/ADDITION USE: (r®Cr/LdP_ 3U X3d 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> o <br /> 1 � <br /> BUILDING CONTRACTOR: I C e <br /> ' to <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O - <br /> � N � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (j <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �" <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mti 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. 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. `z <br /> S. 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, CON TOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> Jo 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI9 TIov� //// i ( o <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. � o p <br /> CONDITIONS OF PERMIT: Qv�N���y <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT F1'r CQ <br /> ISSUANCE. ZQN/ U/VT, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. NG r <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <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 /> W a)ia0MCL* V <br /> 6. garage/storage only. Not to be used for human g 3 a ; it a " � <br /> habitation. z7. y o 3 <br /> o Tom : M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o A <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 with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ° o <br /> M m : <br /> SIGN HERE -JO, 62� 2 3 n <br /> re of owner or building contractor) (date) <br /> v 1: <br /> ZONING ADMINISTRATORS lC <br /> EA EA ER fA 46 N <br /> N V N N O O <br /> Ut O Ut N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED �S- �SC17I <br />