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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> r` <br /> OWNER _ eTELEPHONE (1� t <br /> 1 � <br /> MAILINGADDRESS JIM J �- �-f- '� /. <br /> _� 4 NN s fOS <br /> tJ r <br /> 1 O <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) 3 TWP. 4D R Z L .� V LOT y rO^ (D <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE )4 ADDITION ❑ v l <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISSIION ❑ <br /> aa <br /> STRUCTURE/ADDITION USE: �t1z� �i�l o <br /> (Home abin; Commercial Business; Bedr om; Deck; etc.) U y <br /> BUILDING CONTRACTOR: ° <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> -n <br /> ?1 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m � <br /> 2 .SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO rtl 33 <br /> CENTERLINE OF ROAD,(C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF J Z <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 O <br /> BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N GJ <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. ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° ,C <br /> NEEDED. <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 <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINIIN)r WAI I R FTI: AI I nWFn WITHIN THE RFOI IIRFn WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> e. garage/storage only. Not to be used for human a, n r a o n o v <br /> � � m ° � o_ fm <br /> habitation. m �'c 3 a 2 F R 2. A <br /> 6. o� � ymo � 3 <br /> Z c VI O O O <br /> 7. o m mom : <br /> m <br /> I declare that this application (including any accompanying schedule) has Deen exammea Dy me ana to the pest of my 0A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o 4 C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ( c m <br /> that this information I am providingwill be relied upon b the Count of Burnett Wisconsin in determining whether to is- w 1 1 <br /> Y Y Joi <br /> 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 <br /> providing in this application. I agree to permit county officials charged with a i r inances or other <br /> authorized person t have access to the above described premises at any reasdn o t i ti n. T Q <br /> ce D <br /> CD a <br /> � a <br /> SIGN HERE ^ <br /> (signature of owner or building contractor) JUN (date� ° <br /> 69 <br /> i <br /> ZONING ADMINISTRATOR <br /> BURNETf COUNTY a <br /> O N Ol W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS r� +�SHALL EXPIRE ONE y �C� O A�I�C� <br />