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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> VI <br /> C <br /> � ��y� <br /> OWNER O ( C— L TELEPHONE -y <br /> I 9 O <br /> m <br /> MAILINGADDRESS 3 d O <br /> o <br /> r ! , fie/ uJ 5511 <br /> PROPERTYADDRESS Y 7 ��� f2r zrQ.rrt I� <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) S m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ (� <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADIN ❑ CAMPING UNIT El SUBDIVISION ❑ <` <br /> STRUCTURE/ADDITION USE: 7 cJ( n 0 <br /> e/Cabin; Commercial Business; Bedroom; Deck; etc.) 2. <br /> T <br /> BUILDING CONTRACTOR: <br /> c <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> 11 <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE CD <br /> NORTH(N). Cl) o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <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. t 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. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS :3 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. P» 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: ( ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Fj <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5 This structure to be used as private residential <br /> garage/storage only. Not to be used for human X �o d r > o n o m <br /> 6. habitation. (D F3 a F n "_ A <br /> =r <br /> 0 'oo` er3 <br /> 7. Z cy � o <br /> O m mC/). . <br /> 1 declare that this application (including any accom ., .,.a a.,.. .., l..0 best of my 69 A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofv n <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ° cn <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 w O <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other CD <br /> authorized person to have a ess to the above describee premises at any reasonable time for the purpose of inspection. m n <br /> 99� CD <br /> SIGN HERE <br /> (signature— <br /> of own or building contract (date) { 0 <br /> ZONING ADMINISTRATOR /1 m <br /> 69 69 <br /> EAow - N <br /> O m O N N VI O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT Stlerrn;-bP RE ONE YEAR M04lFROM d- --DTE O` )I e4�Eq �O <br />