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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 /> N <br /> C <br /> CD <br /> OWNER Lam_ TELEPHONE <br /> m O <br /> MAILING ADDRESS <br /> 9 7 v zi ` -7 'Alae s So y <br /> j <br /> rh r m <br /> PROPERTY ADDRESS b!2 ,I( ) <br /> � 19T• q . 15 <br /> LEGAL DESCRIPTION(see tax receipt)'ip C iS C16V cot1 E 3 g P I 8' <br /> mom. <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 4. C <br /> TYPE OF PERMIT(S): `� Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ElR, . <br /> q� y N <br /> STRUCTUREIADDITIONUSE: .r�/QA� �� � /� m <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR e <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O n <br /> 37 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m � �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE �j <br /> NORTH(N). N c <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 /> 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. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED, ry <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 VERIFI ONE WHEN <br /> NEEDED. %N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J� c 1 <br /> CONDITIONS OF PERMIT: 4Pq 1 9 W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OFI/J' <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI Co <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 161% �11/� <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> s. This structure to be used as private residential M n r a v a v M <br /> garage/storage only. Not to be used for human N m r1 m a m <br /> o (Dam <br /> 6' habitation. aCD 3 m ac y 0 o � <br /> 7. ° m <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m r^ <br /> PP ( 9 Y ) Y Y : G>2 : , C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of W o :v , m <br /> E : <br /> au <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize fj�: m m o my <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 ro E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> m rn i <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o <br /> CD <br /> CD <br /> SIGN HERE <br /> (signature owner or building contractor) (date) <br /> ZONING ADMINISTRATOR UIIY( I ILIIfl _ <br /> Q (A 69 <br /> 0 ( <br /> (NNJ1 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED �y v 11 �v <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />