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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator v M z <br /> APPLICATION FOR LAND USE PERMITS ° <br /> UT <br /> N 0 A)N <br /> CD <br /> C <br /> /�^ <br /> OWNER /'E �/Y 2C Y A� TELEPHONE <br /> 1 O P <br /> MAILING ADDRESS -7 Re, 1,� r <br /> L m <br /> 0 <br /> PROPERTY ADDRESS <br /> a <br /> LEGAL DESCRIPTION(see tax receipt) E:e 3!� -TLA) P 3 CL /pu L or m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREADDITION ❑ CO o <br /> TYPE OF PERMIT(S): R 1 C <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVIS ❑ ((-OTS 5 6 7 n <br /> J I ) < <br /> /t <br /> STRUCTURE/ADDITION USE: L2 0 o2 o <br /> /��+ (Home/Cab' mmercial Busine , Bedroom; Deck; etc.) y <br /> BUILDING CONTRACTOR: a/47on L/3 K E �n�S <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 (1\ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _ \ <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n a <br /> o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. zm m D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 /> � <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(OF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <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,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c C� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 ) <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 t <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential m m d > v a v -0 <br /> 6. garage/storage only. Not to be used for human a m a 2. M <br /> habitation. a m c y y o <br /> N m R G <br /> 7. Z o Tom : M <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my _cr <br /> cr ' O <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m r. ifl C <br /> CL 2 : 0 Xt <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize ° m $ : o 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 d <br /> P p ty y ty of Burpett:r n ,on this information I am ID <br /> providing in this application. I agree to permit county officials charged with adhii Isterin rr y�ordinances or other m i E <br /> authorized person to have access to the above described premises at any refit! b_trme�io�ej6se of inspection. m m ; Cn <br /> (D 0 <br /> CD m <br /> SIGN HERE n - S- 3 to m <br /> ( gtura of ow r building contractor) . - C^ '-"� (hate) ` n <br /> ZONING ADMINISTRATOR c vl��t <br /> or <br /> 7 �'V I . (J <br /> TOWNSHIP PERMITS MAY BE REQUIRED _ `NE` C <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />