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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> OWNER OA W AI Jl / /I N C E&- VH 17iF TELEPFIONE<�/ 5� <br /> Q <br /> MAILING ADDRESS <br /> Q12a jo(27d rrf /rORI A (all SS�FI�f 07r <br /> PROPERTY ADDRESS /" oye/yiyc, OoY L/J /�C e E,ogEkI C- I o <br /> LEGAL DESCRIPTION(see tax receipt) / ' �_ 3 Or 3 <br /> DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION ❑ <br /> TYPE OF PERMIT(S): n <br /> FILLINGIGRADING ❑ CAMP G UNIT El SUBDIVISION ❑ 2; <br /> '' // N <br /> STRUCTURE/ADDITION USE: OA A G NO P Ks yo f, ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> 5� <br /> BUILDING CONTRACTOR: ,_ 2 <br /> � � r <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O " _ <br /> -iO N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> m <br /> � z <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 /> C 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 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. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. E <br /> o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY a <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAININr:WAI I G FTr. At I OWFD WITHIN THF RFOI IIRFn WATFR <br /> SETBACK AREA. <br /> 5. This structure to be used as private residential <br /> A WOr D O DOM <br /> garage/storage only. Not to be used for humang ; g g 3E ymA <br /> m x3 am <br /> 6' ac 'a <br /> habitation. o I C <br /> 7. o mNit'0 <br /> = y ; 1 i m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m d' O <br /> PP ( 9 Y ) Y Y �2 ? N C <br /> knowledge and belief It is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of ' <br /> A <br /> o. » _ <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize ' m 5 : 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> O : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information lam m ; Q ; <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorize on to have access t the above described premises at any reasonable time for the purpose of inspection. 1D c <br /> T <br /> q p A 6 i <br /> SIGN HER 4.o-a_ s . / � 0b �+ a <br /> (si tur <br /> aowne r/b�uiill'diigg contractor) (date) <br /> ZONING ADMINISTRATOR <br /> �fA fR 6iM � N <br /> O N N W W N O <br /> O N O N N U O <br /> TOWNSHIP PERMITS MAY BE REQUIRED q <br /> THS PERMIT SHALL EXPIRE ONEY AR FROM D TE ISSUANC <br /> 'V"rm� 1e+-kr - kP ty�Q Wn t` Kll hT�r-1t7 <br />