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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator _0 o o <br /> APPLICATION FOR LAND USE PERMITS 2. <br /> r <br /> F o <br /> N <br /> C <br /> 2 d <br /> OWNER ^ . r,p O TELEPHONE —7 L57, &-r J Q <br /> v � <br /> MAILING ADDRESS a w fC _ m <br /> PROPERTY ADDRESS <br /> Vr UW I 30 � <br /> LEGAL DESCRIPTION(see tax receipt)S( � � y �l/p d <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ � ° <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o; <br /> STRUCTURE/ADDITION USE: ���� `r � ° <br /> m�C 7 <br /> (Ho abin;Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: _ <br /> v <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> 71 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n w <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). y c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. p <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 /> S. 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. m o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. (, 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z IjKJ; <br /> CONDITIONS OF PERMIT: g <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V� <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK A EA. <br /> 5. <br /> This structure to be used as private residential M n r a v a a <br /> 6. garage/storage only. Not to be used for human m 3 a0 <br /> g a <br /> w H - <br /> habitation. -2 H� <br /> 7 c <br /> o E M <br /> m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my G)c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of an i in <br /> a U � <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m S : o mt7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m'• <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 E m E E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m E <br /> authorized person t have access to the abor described premises at any reasonable time for the purpose of Inspection. (D c <br /> SIGN HERE <br /> signs re of owner or_Wjldi g contractor) ( ate) <br /> N i i <br /> ZONING ADMINISTRATOR i '• <br /> O 0 6S 69aN <br /> Kv fNN " <br /> J� O fn fi� O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />