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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator ID O Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> N O ^ <br /> OWNERIF IC..H/'i r0 E. k 4 ! G A n/ 1 c/ TELEPFIONE //S-(J (�b 0 y <br /> MAILING ADDRESS 6 6 8 t i <br /> m <br /> 0 <br /> PROPERTY ADDRESS c 03 O ��/ per, f <br /> � Nr <br /> LEGAL DESCRIPTION(see tax receipt) I'�� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION V 00ZI,0 <br /> TYPE OF PERMIT(S): 1(� r-- t <br /> FILLING/GF4NG ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o <br /> ©� <br /> H <br /> STRUCTURE/ADDITIONOSE: 3a T 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc. ( Q <br /> � I <br /> BUILDING CONTRACTOR: C <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR TO <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A Rt <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 1 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <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. <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. <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN " g <br /> S. <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 Q <br /> ISSUANCE. CM <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 /> ETBACK AREA. <br /> 5. 71F This structure to be used as private residential M o r.- D v a v <br /> 6. garage/storage only. Not to be used for human 9 3 a m R ?m <br /> habitation. z a m <br /> 7. <br /> o 'n ` E m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my <br /> r^ ' <br /> PP ( 9 Y ) Y vr C <br /> knowledge and belief it is true,correct and complete. I acknowledge that i am responsible for the detail and accuracy of id n^� : vi <br /> • <br /> OE : v, m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c o G <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- l : m'• <br /> i G) <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 o E : <br /> m i i <br /> authorized perso o hav access to the ab s d scribed premises at any reasonable time for the purpose of Inspection. - c , <br /> SIGN HERE "' <br /> (signature of ow or building cont ctor) (date) <br /> ZONING ADMINISTRATORlY� : <br /> ( O0 f1 fA 0 N <br /> Nl, I'DO, N O O <br /> L� TOWNSHIP PERMITS MAY BE REQUIRED <br /> YHI PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />