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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator 'D 0 z <br /> APPLICATION FOR LAND USE PERMITS . ` <br /> m <br /> kl <br /> OWNER 1 .X�ti^I°� TELEPHONE 7��^' O Gip - a 71f y w <br /> MAILING ADDRESS 3 S <br /> (� <br /> r <br /> PROPERTY ADDRESS Z 2 ,163 n o <br /> . .��. �i v�1 [`d <br /> LEGAL DESCRIPTION(see tax receipt) �G C 0✓ 1V Y (may J �f^2 g CCD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ElU 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ElCAMPING UNIT F-1SUBDIVISION ❑ v <br /> rr <br /> STRUCTURE/ADDITIONOSE: a�Y Q o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: ' ✓ DTI y <br /> Z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 'n <br /> 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> :E! o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m 1 h jo <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 0 <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. m o 1 <br /> W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN m Q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a <br /> CONDITIONS OF PERMIT: G <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. Ll <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. Ci L+ f Cl_ This <br /> structiare to <br /> 6 �� ( u v garage storage onle used as private residential m 3 = S " n m <br /> habitation. y' Not to be used `" a m <br /> for human m c <br /> 7. z N m <br /> o Tom : <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — m 0 <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n in C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize a cn : <br /> m O rtto <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 of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E m '• <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o <br /> K, ,cilnla I��r �7--D w <br /> SIGN HERE � <br /> signature owner or buildin ntractor) (date) I,` ` a <br /> ZONING ADMINISTRATOR , iM fflouu uLn-=� '• `• <br /> I6A fA dl N <br /> N(li N 00 <br /> G TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE �j <br />