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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 <br /> 1 n ' !' p <br /> CD <br /> I �1/-Q <br /> OWNER Lac>I V/ PHO ®� r --2-1 <br /> Q e <br /> HOME ADDRESS 1� I f I ��L/ l�Csr 1[� ►`(� , YVL�?tC�tli G] (31 � f0 <br /> m <br /> EMERGENCY/FIRE NUMBER ��, ROAD NAME PI►�C/ l �L �I � <br /> P <br /> LEGAL DESCRIPTION(see tax receipt) p� 3� –�� n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ '\1J to 0 <br /> TYPE OF PERMIT(S): C c n <br /> Q <br /> FILLING/GRADIIAEl CAMPING UNIT ❑ �S/UB(DIIVVI�SION ❑ � <br /> STRUCTURE/ADDITION USE: �r')qL") 3� lU T" 0 w ' <br /> me/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> -JBUILDING CONTRACTOR: 1 1 UU I �LWf �QD W l <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. p <br /> :0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> -n �2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <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 <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. 9 <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. Cj <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. v j <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN = o p <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <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 /> TBACK AREA. 1n �P <br /> 71Yc>oa/ ®I�� L ��,5. A -0 0 r D v D o � <br /> 6 This structure to be used as private residential 0 M. <br /> 3 a Ox a � � <br /> garage/storage only. Not to be used for human = ° <br /> 3 <br /> 7z : - <br /> habitation. o T� m <br /> - � : <br /> I declare that this application (including any accompanying scneauie) nas seen examined by me and to the best of my C) c C <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 ` <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i G <br /> sue a permit. I further accept all liability which m a result of the County of Burnett relying on this information I am �' <br /> providing in this application. I agree to per officials charged with administering county ordinances or other <br /> authorized person to ha to the ab d <br /> MF premises at any reasonable time for the purpose of inspection. -n . <br /> CDm <br /> m <br /> SIGN HERE 1 <br /> 11-11- 02— <br /> (s' re of o r iuilding contractor) (date) <br /> ZONING ADMINISTRATOR y,J <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />