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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS _ Z 1 o <br /> r <br /> y o <br /> Yn, � ay <br /> OWNER c <br /> TELEPHONE <br /> N �fV <br /> . / � <br /> MAILINGADDRESS �/ <br /> / T r (D <br /> PROPERTY ADDRESS � C✓ / „_. /1 .� <br /> LEGAL DESCRIPTION(see tax receipt) U) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ o' <br /> TYPE OF PERMIT(S): � 0 <br /> FILLING/GRADINGAMPING UNIT SUBDIVISION <br /> ❑ o- <br /> t� < <br /> STRUCTURE/ADDITION USE: Q (� 841,6( / � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) (� <br /> m <br /> BUILDING CONTRACTOR: � G � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> -n W l' <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> O m <br /> n o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. To Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n A <br /> NORTH(N). m O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 3 Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O o <br /> BUILDINGS, ROADS, LAKE, LOT LINES. — Q> <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 N <br /> 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> —F ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN $ a. 0 <br /> NEEDED. � 0 0(N\� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: �o q I I <br /> O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. fi <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a 1 O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C` <br /> PERMITTED. t (+ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS. ETC.. ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK AREA. This structure to be used as private residential j 3 <br /> 5. garage/storage only. Not to be used for human <br /> habitation. X � 0 r � o D o v <br /> 6. m a f m <br /> CD :1 3 n m x a <br /> 7. Z No 5'0 3 <br /> o m n <br /> 1 declare that this application (incivamg any accompanying scneouie/ nas Dean exammeu oy me anu to the best of my q A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m' n c^ : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `° m <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am m Zr '• <br /> providing in this application. I agree to permit county officials charged with admi 1 o r v <br /> authorized perso to have access to the above scribed premises at any reason r r s t ' <br /> m <br /> SIGN HERE 1� �5 m a <br /> ✓ : a : <br /> ature of o or building contractor) ' <br /> 6. <br /> ZONING ADMINISTRATOR `v^r <br /> MAR '(d RQ5 U1 <br /> BURNETT COUNTY `' O N ! W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING �� <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM D,,9y,TE OF ISSUANCE <br /> tt4fi /�K <br /> LIm,t 9ti4 -fo w X)arey, s-11 dS_ <br />