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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS Q. <br /> ,y n� <br /> OWNERe TELEPHONE <br /> 9--,A <br /> 7 O (D O <br /> MAILING ADDRESS <br /> o <br /> PROPERTY ADDRESS �7 l (5n LI Iy <br /> LEGAL DESCRIPTION(see tax receipt) <br /> a & Cr' V.e a- J <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION �7r(, o��� �' Q t P <br /> TYPE OFPERMIT(S): <br /> FILLING/GR D NG ❑ CAMPING UNIT ❑ SUBDIVISION a <br /> STRUCTURE/ADDITION USE: AILI 0 /to X a� 0 <br /> 4qHome/Cabin; Commercial Bu iness; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: y <br /> Z � <br /> CD <br /> v <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. m0 <br /> M c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> m a <br /> v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> O <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 <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 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS , o <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> W <br /> F 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 0 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5. SETBACK AREA. <br /> This structure to be used as private residential <br /> M <br /> W 0 CD avM <br /> s. garage/storage only. Not to be used for human m 9 n n <br /> habitation. CD N N fA a- <br /> 7. Z in ,p o ifc <br /> o T2 i M <br /> declare that this application (including an accompanyingschedule has been examined b me and to the best of m r^ O <br /> PP (� 9 Y ) Y Y � <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n Fn C <br /> PP (including Yaccompanying ) g ate ` m ` m <br /> all information contained in this application Includin an schedule and I further declare that I recognize m c o G <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 ; M <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to ave access to the above described premises at any reasonable time for the purpose of inspection. CD ED <br /> 7 <br /> Zr <br /> o : <br /> SIGN HERE / m <br /> (signature of er or building contra r (date) p a <br /> ZONING ADMINISTRATOR ✓YI /F.. L V I <br /> © H/fA• Ge 0 N <br /> m tD N N r N O O <br /> OWNSHI PERMITS MAY BE REQUIRED c o u o 0 <br /> br o0 THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />