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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 ° <br /> r <br /> y O <br /> OWNER 4?� SL\ TELEPHONE 1�� �(� <br /> r� <br /> MAILING ADDRESS R)�v ,� 11 $3 D O <br /> LCAIJCA W <br /> 0 CD <br /> PROPERTY ADDRESS �p Mi ( <br /> LEGAL DESCRIPTION(see tax receipt) r:� j 1 J i 4 o I l w IIro 1 N IL q.,A 1 Sw WC <n <br /> 0. <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREADDITION ❑ o` <br /> TYPE OF PERMIT(S): � 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION E] n <br /> 0 <br /> STRUCTURE/ADDITION USE: _�, aS c o w <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: <br /> w <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _n <br /> y CD <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C O <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 0 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 38N <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. o <br /> O F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 3. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 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 /> 5. This structure to be used as private residential <br /> C 0 �DVDvv <br /> s. garage/storage a onl n ° F m <br /> g y. Not to be used for human m 3 a; ; a "_ M <br /> habitation a c <br /> 7 z y m 0 : ( <br /> 9 i E M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my r^ ` ; O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n C <br /> all information contained in this application(including any accompanying schedule and I furtt I recognize m E o m <br /> that this information I am providing will be relied upon by the County of 8 Nether to cognize <br /> ' m C <br /> is <br /> sue a permit. I further accept all liability which may be a result of the CnrEg$ <br /> i �o eth I amproviding in this application. I agree to permit county officials charge o ty nces or other <br /> authorized person to have access to the above described premises at an easonable time for the purpos tinspection. ' m c <br /> T o <br /> SIGN HERE APR 7 Z . m m `• <br /> (sig at rb of owner or building contractor) te) n <br /> ZONING ADMINISTRATOR <br /> 13URNETT COUNTS <br /> JI✓►� lQ �? <br /> 7r'1A I I A* <br /> Mal/0 60 at cJyle>' /01a5/1-Shed �d,d,�r ro <br /> TOWNSHIP PERMITS MAY BE REQUIRED l/-/p q1 - /km-&- <br /> (n0UlCnoo <br /> Y 7 THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE 19103 ba c <br />