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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' o <br /> APPLICATION FOR LAND USE PERMITS 3 � <br /> I�7 � C � <br /> WOV.St2 ,►JV���� C <br /> CL <br /> OWNER c,,& ��� TELEPHONE / �� <br /> v \ <br /> ArCDO <br /> MAILING ADDRESS ?Ae__�6 !ZYAII ISGA.) Rb <br /> B q to_.t-_T Vr J-5 0 <br /> PROPERTY ADDRESS <br /> C.5 ✓17 P18 i ? i Ar C701/* iAp*3 sic, Z3 nes" YO �• <br /> i EGAL DESCRIPTION see tax receipt) RAPJ9*' !6 was t �wQ�✓' 'f' C' w s c m <br /> "'--�- 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE JAJ ADDITION ❑ Cn 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT El SUBDIVISION Elo. <br /> STRUCTURE/ADDITION USE: � I, ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) to <br /> v <br /> BUILDING CONTRACTOR: CD <br /> i <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O Cn <br /> CA <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O M <br /> m ^ z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M CD <br /> NORTH(N). 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 BUILDINGS MEASUREMENT TO THE ORDINARY HIGH WATER MARK OHWM OF � <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO l <br /> BUILDINGS, ROADS, LAKE,LOT LINES. Qj <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. ca 0 <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> M. <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I <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. .` <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <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 X Im 0 r > o a o 1 <br /> s garage/storage only. 0 =3 a " " a `° i <br /> Not to be used for human c 0 o <br /> habitation. Z C Cn 0 - <br /> o � - <br /> 7. o v - '< i <br /> — u, i r <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my I <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of v 0 <br /> .� . <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c r <br /> that this informatio CD <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- cn <br /> sue a permit. I fu r accept all liability which may be a result of the Count of Burnett relying on this information I am v o <br /> P P Y Y Y Y 9 <br /> providing in t p lication. I agree to permit county officials charged with administering county ordinances or other ( U <br /> authorized p t have-access to the above described premises at any reasonable time for the purpose of inspection. `� a <br /> rn D <br />