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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> yy! w a <br /> OWNER 1 IQ.Y�Qip /��' VI. �y� �Q�. TELEPHONE L��a� <br /> HOME ADDRESS �`�l'3 t Q S FCS L S T�� <br /> CJS O <br /> EMERGENCY/FIRE NUMBER a �� I y ROAD NAME h <br /> LEGAL DESCRIPTION(see tax receipt) / ! '�/► I/� I I r)1 r I , <br /> 111 v ! CDa <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE A ITION ElPRIVY ❑ <br /> FILLING/GRA ❑ CAMPING UNIT ❑ SUBDIVISION q 1 c <br /> STRUCTURE/ADDITION USE: <br /> 0 <br /> ( om / abin; Commercial Business; Bedroom; Deck;etc.) <br /> y <br /> BUILDING CONTRACTOR: <br /> fir <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED, <br /> O G <br /> h � (� <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O � <br /> M a J <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m ? <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 m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF p <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO r o <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> 81 <br /> MUST BE SIGNED AND DATED BY THE OWNER. fo o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o i <br /> CONDITIONS OF PERMIT: O <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 ` <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6 This structure to be used as private residential <br /> -00r <br /> garage/storage only. Not to be used tior human M M. 3 = m <br /> _ � <br /> 7. habitation. <br /> : N C N W o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my CO) . m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a 0 c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m I <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Q ` m <br /> sue a permit. I further accept al ility which may be a result of the County of Burnett relying on this information I am <br /> providing in this application. I a reliabe top it cou ty officials charged with administering county ordinances or other <br /> authorized person to have access o the ab v desc bed premi es at any reasonable time for the purpose of inspection. <br /> - )- <br /> m <br /> SIGN HERE `? <br /> C) d, <br /> (si at e o own r o uilding contractor) (date) . <br /> ZONING ADMINISTRATOR ` <br /> qwwa+fn�' <br /> �'tNrf N N 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 <br />