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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 /-J\I <br /> N <br /> C <br /> 'n/ c Q <br /> OWNER 5'f e� TELEPHONE <br /> 94o R d` � �C0 =� I✓� � m 0 � <br /> MAILING ADDRESS O H, 4 ,�l ICGZ �'1 11/ <br /> PROPERTY ADDRESSQ�j L tat led 1 0 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING E] GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 'S" t rS m 0 <br /> TYPE OF PERMIT(S): I( W <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ q <br /> STRUCTURE/ADDITIONUSE: L0 1)(2y Gqr- "CY)YO)'Y a- L(i` IS�y`S � p o (� <br /> (Home/Cabin; Co clal Business; Bedroom; Deck;etc.) d S w <br /> BUILDING CONTRACTOR:`wh� <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR n (� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> „ y c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T a <br /> tl O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m R <br /> 70 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 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 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 N <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. Q c o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICr]) I BE DONE WHEN y <br /> NEEDED. U Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ) l�j �J/ o <br /> CONDITIONS OF PERMIT: / J/' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF�RMI'l V� C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORE <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 2OA'/�I�/Cnn0Uh'� <br /> 4. NO STI STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WAYS 'V <br /> SETBACK AREA. <br /> 5.ut 'J"m This structure to be used as private residential 70 w r>o a O <br /> 6. garage/storage only. Not to be used for human 2. a ' M <br /> 3 a m 3 <br /> N <br /> habitation. Z m o a <br /> 7. o ;,` ' m <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m r 0 <br /> PP (• 9 Y ) Y Y ? L7� C <br /> knowledge and belief it is true,correct and complete. 1 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 o rn <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 '• 0 E <br /> /•' <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other ,o ; <br /> o <br /> m m i <br /> authorized person to h ve cess tot ab ve described premises at any reasonable time for the purpose of inspection. - c <br /> 10 <br /> 7-0 o i <br /> SIGN HERE Z y d: CL <br /> Mure o owner building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> i E <br /> r N " 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> l� HIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />