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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator v ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> OWNER !�Sa�N 6k N G M u C� TELEPHONE �i l <br /> � C , l � � S <br /> MAILING ADDRESSSfi (leY Erb✓e ' �J/�/ O <br /> CD <br /> PROPERTY ADDRESS � ( <br /> I �� '\ „ d Patzlur� Rifer P1ncs <br /> ( <br /> LEGAL DESCRIPTION see tax receipt) � tom- l.o/--Y7 f in o ccf <br /> DWELLING/BUILDING❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ lots i/ o '3 o <br /> TYPE OF PERMIT(S): y <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �: 1 U <br /> STRUCTURE/ADDITION USE: �� Q(� / (n o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) co <br /> BUILDING CONTRACTOR: <br /> 'o 1 <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 /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O C <br /> -n 0. <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O <br /> n d � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) 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. o <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. O <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. 0 1 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN �i o <br /> NEEDED. 0 Uj <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: t�^ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT V/ 1 vt <br /> ISSUANCE. A <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q Q <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential zc�r a v a o v <br /> 6. garage/storage only. Not to be used for human 2 3 a g F a m <br /> habitation7. . Z y .0 o. " 0 3 <br /> : ;,z : z <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my � A <br /> knowledge and belief it is true,correct and complete. I 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 C o m <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 f rther accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in thisplicati n. I a ree to permit county officials charged with administering county ordinances or other <br /> � . : <br /> authorized perso to v Lace the ve described premises at any reasonable time for the purpose of inspection. '^ Cn <br /> M p <br /> SIGN HERE <^ <br /> (signitUrINA ne or bufldin actor) (date) <br /> n <br /> N <br /> ZONING ADMINISTRATOR <br /> fA fA d) N <br /> N (T MN N 0 O O <br /> (TO (TNOO <br /> TOWN HIP PERMITS MAY E REQUIRED <br />