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'Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator _ o <br /> APPLICATION FOR LAND USE PERMITS <br /> N � <br /> N [� <br /> r.;1 n tom. <br /> OWNER , _ �� F LI�C�t!C L'C T TELEPHONE �S" o p <br /> MAILING ADDRESS ��/ O�� {�` �d ��-&k-& <br /> PROPERTY ADDRESS f � j) E esA <br /> LEGAL DESCRIPTION(see tax receipt) I c NC 3 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE LJ ADDITION ❑ C, U) ° <br /> TYPE OF PERMIT(S): a = <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ c <br /> STRUCTURE/ADDITIONOSE: 'S O l` 310 d Lc cJ/YC` /J ° <br /> _ <br /> (Hom Cabin; C6mmercial Business;Bedroom; Deck;etc.) m Q , <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN P%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O 0 o <br /> ?i O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). CO)G( <br /> ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO 'R <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 GRADED OR FILLED. N O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS �' 3 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o = <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI � � �bm ° W <br /> NEEDED. L )�J/ j EL'' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ' t V ' ) o (� <br /> CONDITIONS OF PERMIT: J�{� ? 9 2w�2 ; <br /> 1 <br /> ISSUANCE. <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE NEn C (� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE.ZONING UN ry V <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. <br /> This structure to be used as private residential W r a O a o rn <br /> s. garage/storage only. Not to be used for human fo s a ,� <br /> m C y " o 3 <br /> habitation. Z m ° <br /> 7. ° : -n : m <br /> = rn : A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 6 — : <br /> c <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of a 0 : �: 55 <br /> all information contained in this application(Including any accompanying schedule)and I further declare that 1 recognize ° O m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is p\ <br /> N <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 application. I agree to permit county officials charged with administering county ordinances or other o <br /> �.: <br /> authorized person to have access to the above de ribed premises at any reasonable time for the purpose of inspection. m : COm o <br /> m m <br /> SIGN HEREjPJ <br /> aa' a <br /> (sign re o caner or building contractor) (date) f� <br /> ZONING ADMINISTRATOR u, <br /> fA fA 459 69 (A N <br /> N V N N 0 0 <br /> ri OUN °T OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />