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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 /> y O <br /> N <br /> C <br /> N <br /> OWNER _ r I ) P P c YYl 3= TELEPHONE o <br /> ,^ 1' �/ O <br /> As5 h <br /> MAILINGADDRESS ��� er �r eAue( �eeK DHi() (S <br /> n ' � <br /> PROPERTYADDRESS �22 33o H `) D D LE rn �_e uz j f, �o(J jje r 1JI C0:0_� t <br /> /P <br /> LEGAL DESCRIPTION(see tax receipt)C S�'1 v # )_3 P l7 c- +' ) Cn] �/ C _� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ C� TO� c ° <br /> TYPE OF PERMIT(S): a <br /> FILLINGIGRADING 11CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDmONUSE: Cl 9)11 G W 2lqGE r x <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: v h� �a 1 �' L) ��e V-S d <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> z y � � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T m <br /> *n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). Cnn 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m W 3 <br /> v <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. v ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q <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 q � <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ll� <br /> NEEDED. QN <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 /> SETBACK AREA. <br /> 5. �(C�}�-� This structure to be used as private residential ; 0 d v a v m <br /> s. <br /> garage/storage only. Not to be used for human g. 3 R g i< a �°— <br /> habitation. z N m ° N ' 3 <br /> 7. o 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 —�, m n v, <br /> CL in : <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m 0 : mm <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 d <br /> providing in this applicatl . I agree to permit county officials charged with administering county ordinances or other 3y <br /> authorized person to have ccess tote ove d cribed premises at any reasonable time for the purpose of inspection. o <br /> / m m : <br /> SIGN HERE n <br /> (sign of ow r or building contractor) r (date) <br /> ZONING ADMINISTRATOR \ <br /> r <br /> OdN 0 1r') NfON <br /> (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> O (T 0(T0100 <br />