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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o <br /> APPLICATION FOR LAND USE PERMITS 3. < -�j <br /> N <br /> N <br /> OWNERl"' TELEPHONE <br /> A <br /> f :° IIINNN <br /> MAILINGADDRESS O <br /> 1�/ ' 1Qy <br /> i I �m <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) C �U d <br /> a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ c 0 <br /> TYPE OF PERMIT(S): rr <br /> FILLING/GRADING ❑ AMPING UNIT ❑ SUBDIVISION ` , <br /> STRUCTURE/ADDITION USE: i.tk,27rj yr �� 0 <br /> (Home iBeUommercial Business;Bedroom; Deck;etc.) Cn <br /> m <br /> BUILDING CONTRACTOR: m <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> ;U N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> m o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 ao A <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 n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. 1 0 <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. ` N SCJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRA T ETC., THE PLANS =. <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0QS <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI MA E� S <br /> NEEDED. / f <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Jut p <br /> CONDITIONS OF PERMIT: 4 201 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITBURNE�CO 1 I <br /> ISSUANCE.2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ZO/V Q UN <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5. SETBACK AREA. This structure to be used as private residential <br /> garage/storage only. Not to be used for human ; d r'>o a O v <br /> 6• habitation. g 3 'o. m F a m <br /> � <br /> 'O R C <br /> 7. Z 0 N 0 'O <br /> .0 21 z <br /> I declare that this application (h. ,the best of my ^ O <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of d no iA C <br /> : u �0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recn^ <br /> ognize m C : 0 : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (D <br /> G) <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am D <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to DR,e access to the above described premises at any reasonable time for the purpose of inspection. m ? m s <br /> o <br /> CD <br /> G] m m <br /> SIGN HERE /- o. <br /> (signature o olor bugong contractor) ate) <br /> ZONING ADMINISTRATOR <br /> d+F» <br /> ffl(\ ri ri 0 N N N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />