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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> CD <br /> OWNER ` '/)/�.� I/VI Ili 81"S D TELEPHONE 7/J — Z�— 3G O� a a <br /> ,��VVv <br /> vV o J: <br /> MAILINGADDRESS Z 8 SLS , <br /> ^ JJ ,,�� h� 0 <br /> PROPERTYADDRESS SAAA15 v o <br /> LEGAL DESCRIPTION(see tax receipt) U <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ r n <br /> STRUCTURE/ADDITION USE: <br /> 0 <br /> o � <br /> nv (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) W <br /> BUILDING CONTRACTOR: L ���/ ���i �O/✓SrIZuCT1U/✓ <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR N n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO 3 ^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m \! <br /> n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n a) A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m o <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 ° l <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. n <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. O <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 /> 5 SETBACK AREA. This structure to be used as private residential <br /> garage/storage only. Not to be used for human X m O r D o D v v <br /> CD C W o0o. F m <br /> 6. habitation. F 3 a C ; a <br /> 'o p m C y <br /> 7. Z cm' ID0 <br /> P m -n`< m <br /> I declare that this application incivam an accompanyingscneou�e nas oeen exammea o me and to the best of m � - A <br /> PP 1 9 Y 1 Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- rn <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 aO o <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person tp have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> T a <br /> m D <br /> CD <br /> SIGN HERE an a <br /> (signature of owner ilding contractor) (date rr,,''. o <br /> W: <br /> �y r <br /> ZONING ADMIN �' I ' l ( <br /> Q�EAfAfAEA�N <br /> Pa to Rofn /b y-93 *n31lL V O N J J N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />