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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 /> UT o <br /> OWNER j)4,60.2F✓` TOl.. l3F•Plr TELEPHONE 19f2 <br /> HOME ADDRESS Alf �d�JO/I�/G'�1✓�P /%//Y/��rlJ/J•C�i� �/il/� �5 �' ou <br /> EMERGENCY/FIRE NUMBER ROAD NAME Gk.557 <br /> LEGAL DESCRIPTION (see tax receipt) G'Ovr ,Cor 7 Srel-g yo/1/ m <br /> ��� cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIVY ❑ Q m <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADI <br /> NG ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n. <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) ? ` <br /> BUILDING CONTRACTOR: ��Tiy,G.CziN1J �Gf�GOt��S /B m <br /> m <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 4 a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'o 0 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> l p ) <br /> 5. /� C,tJ v 1"(l <br /> l M d 0C a f m <br /> 6. U Phis structure to be used as private residential 3 a 0 ; a <br /> garage/storage only. Not to be used for human z ° o o N -4 <br /> 7. o Tom : m <br /> habitation. _ �, <br /> I declare that this application (including any accompany of my A <br /> knowledge and belief it is true, correct and complete. I a acy of o 2 ;a <br /> Inn <br /> all information contained in this application(including ar ignize m m <br /> that this information I am providing will be relied upon by __..._. ....,nmmlu wnemer 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 ° <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> CD <br /> authorized person to have access to the above described premi tatty eQrtable; r+e fieFElae purpose of inspection. -n <br /> m <br /> ZOO/SIGN HERE )J'r lJ 1 .0 iOO/ 69 i <br /> (signature of owner or building contrac date) <br /> ZONING ADMINISTRATOR � . 7 �i! <br /> TOWNSHIP PERMITS MAY �OIJNTY <br /> G <br />