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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 /> VT O <br /> N <br /> / + a <br /> OWNER V }A -e a? y TELEPHONE 7�S 6 S" G� c?o7 s 2, 0 <br /> HOME ADDRESS y yy, .y - S3 <br /> r <br /> d <br /> EMERGENCY/FIRE NUMBER �/�, ROAD NAME <br /> �r , V _JCCD LEGAL DESCRIPTION(see tax receipt) L 3 GS 7�1 3 P ♦$ ( N /"2 .T4) �' �l <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE �I ADDITION ❑ PRIVY 1 Cl)TYPE OF PERMIT(S): I C <br /> a <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION El <br /> n <br /> STRUCTURE/ADDITION USE: \o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> 'v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n a t\ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn <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. ° <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GR R FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDE TC.,THE PLANS �. <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VE ICATION MAY r <br /> OII(kms o ? <br /> JAin <br /> NEEDED. W � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. f o j <br /> CONDITIONS OF PERMIT: BURNETT 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P RMIZ N NG UNT�C i <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �l <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. <br /> 5. This structure to be used as private residential X v d r > °a f m <br /> 6 garage/storage only. Not to be used for human g. a 2 N a a A <br /> m C <br /> o y o 3 <br /> habitation. y '^ ° 7 <br /> 7. o it <br /> - � : m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. n <br /> CD <br /> n m <br /> SIGN HERE <br /> I1} vi <br /> (sig ure o owner or buildingco for �. (date) <br /> ZONING ADMINISTRATOR <br /> v 1 <br /> T NSHIP PERMITS MAY BE REQUIRED <br />