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Burnett County 7410 Co. Rd. K, No. 1102,Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 00 <br /> OWNER TELEPHONE 8�6 `�6 2C a �O HOME ADDRESS L �' <br /> L � _y� n. .S 7J� <br /> I r m <br /> EMERGENCY/FIRE NUMBERa g 3 �, ROAD NAME T�//CjhU[�, ><� /� O o <br /> int 6 d c <br /> LEGAL DESCRIPTION(see tax receipt) Ca ? ; yU k 16 w , P 2 �.,,&o f j OJAG m tle AL✓• <br /> d <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 5d ADDITION ❑ PRIVY ❑ (n <br /> TYPE OF PERMIT(S): rr <br /> a ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> `` N <br /> /` �\ <br /> STRUCTURE/ADDITION USE: l�G.r G �b � �� ° <br /> f ome/Cabin; ommercial Business; Bedroom; Deck;etc.) Cn <br /> N <br /> BUILDING CONTRACTOR: UWv 6A1 t /Y1(((/ —h&y a <br /> v <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. T ZN <br /> vL' <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> a I Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. W ',o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(N). y 3 <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 1 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO ` o <br /> BUILDINGS,ROADS,LAKE, LOT LINES. `r t> <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS S 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. o O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. L�f �T�'rr �j o <br /> CONDITIONS OF PERMIT: G' �7 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P MIT ,I p <br /> ISSUANCE. .JUN 9 200, Cf <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SH OR � Cj <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY%UNE 7 <br /> PERMITTED. „^^--,,..Cou(, <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED Vt�4HAJ/ G <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential X ' d iu O O m <br /> 6. garage/storage only. Not to be used for human a a y o . 3 <br /> habitation. ” H H o `• 7 9 <br /> 7. o �� <br /> _U' : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a e <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m : : M <br /> M <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y G <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m <br /> providing in this application. I agree to permif county officials charged with administering county ordinances or other m <br /> authorized person to have qalqass t e described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> (DSIGN HERE <br /> 46 1 <br /> ( nature of owner or building contractor) (date) <br /> ZONING ADMINISTRAT Ri 4 <br /> -N PQ M N K)(A fn <br /> V-A -bD �1�' ��SS -# LnNo � Poo <br /> 0000000 <br /> WNSHIP PERMITS MAY BE REQUIRED a2 {_ V/ — o 0 0 0 0 0 0 <br /> �P <br />