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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS . <br /> N O» <br /> _ C <br /> OWNER TELEPHONE <br /> �T �I / 1 © zi)— ?4?/ ii IVI�_1 <br /> - <br /> T. m <br /> MAILINGADDRESS <br /> PROPERTY ADDRESS , S r] -r-t��J/1 �Q y �QL. , <br /> i <br /> LEGAL DESCRIPTION(see tax receipt) t� m <br /> DWELLINGBUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION Ely O <br /> TYPE OF PERMIT(S): i¢ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: 1'i 0 <br /> (Hom bin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: >l� 4 e/�S f/(/[' <br /> v <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. p <br /> nnnn 0 y G <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) �k l�l� O <br /> O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A 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 _o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m o <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. <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 0 J� <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN » <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ry L w <br /> CONDITIONS OF PERMIT: U)it <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c, <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. JJ <br /> 5. i5ar-a3 4-o be. ? ID' -167-OM CJ rO In-FI?-1 <br /> W m m 0 m a f m <br /> 6. This structure to be used as private residential g a 'a io x n <br /> 7. <br /> garage/storage only. Not to be used for human z w .o y = a <br /> habitation. _ ° rn i im <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of oo 'm m : L <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize C <br /> that this Information 1 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 liabili which may be a result of the County of Burnett relying on this information I am <br /> providing in this application. I agr t permit county officials charged with administering county ordinances or other <br /> authorized person to have access th above clescribp&o-rehilses at an eas able time for the purpose of in pection. ' m o <br /> m � m <br /> SIGN HEREKAIWI(rd' <br /> of owne�r'or building <br /> /c�oni�rr) (d a) Fits <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS P RMIT SHALL EXPIRE ONE YEAR FRPM DAT FbOF ISSUANC�, <br /> c <br /> Q/rnt I- 1 1 'L P� kL L,(p L, <br />