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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 /> /J� � /'� ), ) <br /> OWNER n'„, / // ^^ TELEPHONE <br /> (__a <br /> MAILINGADDRESS JLLo� j( PP � F�`y(� I�/ �� Jr�,��� `" CA O <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) y <br /> m <br /> 2 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION N <br /> TYPE OF PERMIT(S): � c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONcli, ❑ n <br /> STRUCTURE/ADDITION USE: R� `b 0 <br /> (Ho e/ abin; Commercial Business; Bedroom; Deck; etc.) N ,� <br /> m <br /> ?. <br /> BUILDING CONTRACTOR: <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. TO <br /> A H <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) O m <br /> -n n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m !? <br /> NORTH(N). C Ci <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 p <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. J <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS d 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> ] 7 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z Io P <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 7.1 <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 <br /> PERMITTED. I fy <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS. ETC.. Al I nwFn WITl-nM Tuc Dcni <br /> SETBACK AREA. <br /> 5. This structure to be used as private residential <br /> 6. garage/storage only. Not to be used for human M m d d g o c, o v <br /> > > n n n £ m <br /> m �r3 nto , . m ;ohabitation. a o m C N y o ,= 3 <br /> 7. Z Hin � o Dmf <br /> D m r'< : m <br /> 1 declare that this application (including a.. — 2 <br /> PP ( a r accompanying scneaule) has been examined by me and to the best of my D <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of [ m n <br /> all information contained In this application(Including any accompanying schedule)and 1 further declare that I recognize [ m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ' I i `� ' vn : t7 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am : m : =o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> v : <br /> authorized person to have access to the abo described premises at any reasonable time for the purpose of inspection. <br /> TI n <br /> D ; <br /> SIGN HERE <br /> �tuu'rree�of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> TH PERMIT SHALL EXPIRE ONE YEARF OM DATE OF ISSUANCE . <br /> �up <br />