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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N 0 <br /> N <br /> CD <br /> OWNER /�, C��/C IJ L / l TELEPHONE /J�' G� v .j 1 �O <br /> O <br /> MAILINGADDRESS �2 S B <br /> 0 <br /> PROPERTY ADDRESS 54 m L i <br /> tirr- swat=z �v ' � sw J <br /> LEGAL DESCRIPTION(see tax receipt) s /� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ yy��CAMPING UNIT ❑ SUBDIVISION <br /> r J❑ / �/ <br /> STRUCTURE/ADDITION USE: OM 1-` r/4 Z. U 7-1 L- / Ty I�Z-Z� /ln X a 'K C <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) 0 <br /> BUILDING CONTRACTOR: <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m - <br /> I'0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 5 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m AS <br /> NORTH(N). C 0 <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. 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 a <br /> MUST BE SIGNED AND DATED BY THE OWNER. f I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> z <br /> NEEDED. �. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: Q� <br /> UJ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <br /> ISSUANCE. <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. d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5m <br /> This structure to be used as private residential z or, > 0 > 0 v <br /> 6. garage/storage only. Not to be used for human 2 3 R 2 x a� � <br /> habitation7. . z ° �oa. <br /> 3 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n v, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Co <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 o0 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person t a access tot the above described premises at any reasonable time for the purpose of inspection. fD <br /> oID : <br /> oy�l7- c�3 <br /> SIGN HERE `^ <br /> (signature of owner ing contractor) (date) n <br /> ZONING ADMINISTRATORCct l� <br /> fA d1 fA EA N <br /> O CNi O N(Ni 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED O <br />