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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3• P� <br /> r <br /> N C <br /> N <br /> C <br /> QI <br /> OWNER h C , ( C1 S TELEPHONE <br /> m <br /> HOME ADDRESS ✓° -7 qq C D O <br /> I / J• �ht A. �G N�`C�O Tom'/ Wr - ,� yf✓ r 9 <br /> � O <br /> EMERGENCY/FIRE NUMBER 3 7 9 9 ROAD NAMY`yL/ �� v/G rj I <br /> I �JJ <br /> LEGAL DESCRIPTION (see tax receipt) h!� / C--�M v � ' �• I $� 1 C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 9L ADDITION ❑ PRIW ❑ C� m <br /> TYPE OF PERMIT(S): v /� <br /> FILLING/GRADING El CAMPING UNIT El SUBDIVISION Ela <br /> N <br /> STRUCTURE/ADDITION USE: 3oX.3G c1a�� G—� le A� <br /> (Home�abin, ommercial Business; Bedroom; Deck;etc.) 0)BUILDING CONTRACTOR: /!O/• G h 41,3 C• I' 10 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> � Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m d r <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE FF 7D <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 <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 /> 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. o <br /> O 1 (1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q 0 <br /> NEEDED. 2 <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 I <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. 1[/ <br /> 5. 17� F�IL j— W 'D0rm- g ka -0 <br /> This structure to be used as private residential C 3 a$ '0 a z <br /> 6. / garage/storage only. Not to be used for human c N y o s 3 <br /> 7. / habitation. o : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my t7 p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofr. c <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize Q . <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> / m <br /> SIGN HERE dim 1/ 4 G <br /> (signature of o er or building contractor) /7 (dat ) <br /> ZONING ADMINISTRATORr/� <br /> cn yr cn cn cn <br /> N NfTNN0 (T <br /> q&tlle- <br /> ILLe <br /> D/7µ/'TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />