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Burnett^ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator c) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N ti <br /> OWNER YAG W/ �.�/rs TELEPHONE��L✓�(�'��� n <br /> 0 <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER y� ROAD NAME <br /> LOT )I S<i1fa. <br /> LEGAL DESCRIPTION(see tax receipt) Aril y m <br /> DWELLING/BUILDING ❑ GARAGE! CESSORY STRUCTURE KADDITION ❑ PRIVY ❑ (I} Cn 0 <br /> TYPE OF PERMIT(S): V c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ U a <br /> STRUCTURE/ADDITION USE: ,l!e IL(fo1& <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: 6 Z <br /> � t7 <br /> v <br /> m <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. 0 <br /> :0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> -n o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m30 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn n <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. —b <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. <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. 'c <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a <br /> NEEDED. 2 ( n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> c <br /> CONDITIONS OF PERMIT: <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. <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 /> 5. SETBACK AREA. This structure to be used as private <br /> residential garage/storage only. Not to be A _0 0 r o o <br /> 6. <br /> m. c � <br /> used for human habitation. =N ^ o' <br /> = 3 <br /> z : yW� o � <br /> 7. o '1—ur <br /> M <br /> I declare that this application (in. ___.. . ..y Ilia anu 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 o <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m G <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 <br /> authorized persto have accen to the above described premises at a y reasonable time for the purpose of inspection. T <br /> CD : <br /> M <br /> SIGN HERE 14- <br /> (sig re of owner o&w0ing con actor (date) <br /> ZONING ADMINISTRATOR <br /> M M M M M M <br /> N N(T N N 0 V1 <br /> V1 V• O V1 V1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />