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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> - r <br /> N O» <br /> C <br /> OWNE //�z//,BOG /, i�� } / <br /> TE'J P"°�/S r� S— 0 <br /> MAILINGADDRESS� CAI <br /> `D O <br /> PROPERTY ADDRESS A� <br /> LEGAL DESCRIPTION(see tax receiptL'� 9 ,� �� T Cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ (n o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> wok!t S N - <br /> STRUCTURE/ADDITION USE: �, o <br /> / (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> BUILDINGCONTRACTOR: eST��� <br /> m <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 B <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> it Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. � <br /> n o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <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 <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. <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 0 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> f _W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN O <br /> NEEDED. <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z V <br /> CONDITIONS OF PERMIT: 0 7 1 <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 /> 6 This structure to be used as private residential <br /> garage/storage only. Not to be used for human X n r D O D v v <br /> 6. habitation. 3 a mO x a (, z <br /> 7 v N C y y o 5 <br /> Z y m 2 7 <br /> o T M <br /> I declare that this applicati. --••-- pined by me and to the best of my p <br /> knowledge and belief it is true,correct and complete. 1 acknowle a e detail and accuracy of <br /> all information contained in this application(including an acco n c <br /> PP ( 9 Y hQr actors that 1 recognize m o : m <br /> that this information I am providing will be relied upon by the C ty of Burns n twrdi Ing whether to is- <br /> sue a permit. 1 further accept all liability which may be a resul he County of Burnett relyin tlhs information I am d <br /> providing in this application. I agree to pe .t county officia ar ed` a�m i is erin cou rdinances or other <br /> 9 � <br /> authorized person t have access to the ab a described pre at any rrea3orlal>� or thu,'rbose of inspection. m Cl) <br /> B -n o : <br /> SIGN HERE �� URNE!7T�'ioU �j m <br /> w m : <br /> G <br /> ignature owner building contractor) (date) <br /> ZONING ADMINISTRATOR IGYI <br /> w en <br /> w w w wN <br /> N N N N O O <br /> fT O (T N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />