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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - G 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N <br /> CD <br /> OWNER l TELEPHONE solen <br /> Q <br /> MAILINGADDRESS C)?) C; '.VGb � :3 <br /> m <br /> PROPERTY ADDRESS (Ot17-7 C 1+ I lin k UIt f7 1� -i, o <br /> LEGAL DESCRIPTION(see tax receipt) C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE © ADDITION ❑ O o <br /> TYPE OF PERMIT(S): V)Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> T. <br /> STRUCTURE/ADDITION USE: O <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> � °�,, <br /> BUILDING CONTRACTOR: Ll-V� <br /> ,v <br /> m ! <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 w <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T nn <br /> ;U �l <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y w o <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 T 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 0 U <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z }� <br /> 0 <br /> CONDITIONS OF PERMIT: i <br /> d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W � <br /> ISSUANCE. v <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. [7 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS. ETC . ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> CD WC� rDC7DoIV <br /> M <br /> 6. habitation. m F 9 a 2 � a z <br /> -60 (D C y N O 3 <br /> Z C � O O O <br /> 7. O m Tom ' rATI <br /> I declare that this application mcluoin an accompanyingscneouie nas peen exammeo o me ano to ine best of m <br /> PP (� 9 Y 1 Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of J o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m mo <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- rn <br /> sue a permit. I further cept all liab" hich may be a result of the County of Burnett relying on this information I am d o <br /> ,ilproviding in this applic ion. I agr a to p rmit county officials charged with ad m i of er `° <br /> authorized perso to ve access t the ove described premises at any reaso` I �t r o f e i m a <br /> _ m <br /> 05 `° D <br /> m o. <br /> I ev � a <br /> SIGN HERE E <br /> P <br /> ure of own o uilding contractor) APR 2"21055 <br /> W <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNTY N <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING O U O N N N O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROP <br /> DATE <br /> TE OF ISSUANCEaS`� <br /> n-ialLeo1 � 4W re KD/n t3 K y <br />