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Burnett L ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> iT <br /> � o <br /> OWNER /M. TELEPHONE <br /> HOME ADDRESSawA gUb' �z Ppyl MtJ SrjlO'� v <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER 1 1A 7o�3a ROAD NAME �' o [ D `U' <br /> LEGAL DESCRIPTION(see tax receipt) Gov, Lqi3 S i_c Z 1 (7%K-l-Ayu Twp co <br /> CD <br /> g�ow�a <br /> DWELLING/BUILDING ❑ &W We/ACCESSORY STRUCTURE l�1 ADDITION ❑ PRIVY ❑ 0 _ <br /> y <br /> TYPE OF PERMIT(S): � 3T <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> 5. <br /> STRUCTURE/ADDITION USE: C�To1z w R Dr 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: SIF <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. n — <br /> y Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p CD <br /> In a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> M <br /> o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;? <br /> NORTH(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. 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 N <br /> MUST BE SIGNED AND DATED BY THE OWNER. o t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN4 0 <br /> NEEDED. T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential ; 'D 0 r' v v v <br /> 6. garage/storage only. Not to be used for human 3 = m <br /> m.� '(D C o' <br /> 7. habitation. <br /> -F3 <br /> N ° <br /> P :: <br /> 1C): m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m c <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 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- y O <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 p m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> m <br /> CD <br /> SIGN HERE �y � d' <br /> (sl <br /> it <br /> ure of owner buildi p c ntractor) (date) <br /> ZONING ADMINISTRATOR011-1 <br /> cnwwt»cri cn� <br /> N NN N Nut <br /> (T Out VIOP <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />