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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 . oc <br /> yy� C <br /> OWNER Po� -1' l�Q/� ��c,�(�Q(_ TELEPHONE J L� �Z �t2� 0 UJ a •IZ> <br /> w'r%42 *v-4- m O <br /> MAILINGADDRESS t-jL—ry\ if )t` '5-S 11 G <br /> a m <br /> PROPERTY ADDRESS 1i� l'�l k <br /> \�j P� 3 <br /> LEGAL DESCRIPTION(see tax receipt) � <br /> � 3L.1 1 �-�,� C G{ -qo-X � n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ rn <br /> TYPE OFPERMIT(S): a <br /> FILLING/GR NG ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> \ �f N <br /> STRUCTURE/ADDITION USE: �\e 1"^� T 0 ' ,1 <br /> r� (Home/Cabin;Commercial Business;Bedroom: Deck;etc.) mW <br /> BUILDING CONTRACTOR: 5i <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR m L <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M y U' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> -n v Z (n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m jo (� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). No <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <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. P <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Qb <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONT TC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o� o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA ON MAY <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: �R C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT2 ' c U <br /> ISSUANCE. 'M/A/ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY a <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 C w;0> a: rn <br /> 3 a m Ox <br /> 6. garage/storage only. Not to be used for human a y o y <br /> habitation. <br /> 7. o : I,< M <br /> - U) m <br /> 1 declare that this application (including any accompanying schedule)has been examined by me and to the best of my 6 c `' • : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail a d accuracy of a Fn <br /> a u M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o O <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 thi Ii tion. I agree to permit coup officials charged with administering count ordinances or other "I <br /> P 9 P 9 P county 9 9 Y E fc i <br /> (D <br /> authorized pe on have access to a above described premises at any reasonable time for the purpose f inspection. - o , <br /> m m <br /> SIGN HERE <br /> (signatur own or building contractor) (date (� n <br /> W <br /> ZONING ADMINISTRATOR m LGf�✓1 �� <br /> `J fll O(li (T O O <br /> �ry�g� TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />