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Burnett County 7410 Co.Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS I. <br /> OWNER —TrUY L� I �T J TELEPHONE GCD <br /> 3 wy <br /> rP <br /> MAILING ADDRESS <br /> a 6` S e <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) a L3 Cir, ►/ flo(a/ a�—qZ) cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ rn 0 <br /> TYPE OF PERMIT(S): a, <br /> FILLING/ DING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a c� <br /> STRUCTURE/ADDITIONOSE: dQe�/ rm <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: y <br /> CDv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS <br /> � m � <br /> DI E 1 F0 P I PLAN D AWIN : (AERIAL OR TOP VIEW) O a <br /> m <br /> ?t O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m jp <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 o - <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. (a <br /> v � ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT��C/} E DONE WHEN " o <br /> NEEDED. c'{ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ((ff <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE.�NF <br /> 3. NNORGRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY IQ� co <br /> p' <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATE06 N� Q) <br /> SETBACK AREA. <br /> C. This structure to be used as private residential x m 0 v a <br /> f <br /> 6 garage/storage only. Not to be used for human m. 3 a w a m m <br /> - mCH <br /> 7, habitation. Z a o ' a <br /> o m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m y` ` O <br /> PP ( 9 Y ) Y Y Uf <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of E m n : En C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize E CL m$ E 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 further accept all liability which may be a result of the County of Burnett relying on this Information I am ro '• `• <br /> providing in this applicatio I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have#bcess t the above described premises at any reasonable time for the purpose of Inspection. m c <br /> SIGN HERE 2 2� m <br /> i <br /> (signature of r or building contra to) y� (date) ` n <br /> ZONING ADMINISTRATOR <br /> �-6� lino 0 <br /> � <br /> �� �_ / TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE lr� <br />