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Burnett County 7410 Co. Rd.K, No. 102,Siren,W154872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> SU <br /> OWNER � /�. TELEPHONE g6 7// <br /> nn d <br /> MAILING ADDRESS <br /> r � <br /> cy L73 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) L6-t- Opp <br /> — Pll ► 1/f P� -� 1 Oc) m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE /J ADDITION ❑ O o <br /> TYPE OF PERMIT(S): v ' <br /> C <br /> FILLING/GRADING ❑ �CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> T. <br /> STRUCTURE/ADDITIONUSE: r 1'D'7�LQ Ga hay's a7 X.3d <br /> (Home/Cabin; Commercial siness;Bedroom; Deck;etc.) ti <br /> L d <br /> BUILDING CONTRACTOR: �S� L <br /> v <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 C� . <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O 1I, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m , <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m M <br /> NORTH(N). <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 <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ) o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO C <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. SU <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. OV f <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. ,c+'-_ (��J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z `�I <br /> CONDITIONS OF PERMIT: p 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT V 1 C <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 /> s. This structure to be used as private residential r <br /> /33� _u�� �y� or- > 0 > 0 <br /> garage/storage only. Not to be used for human ��� _g 0 a g g a m m <br /> 6. habitation. �^ ' I C " F o 3 <br /> 7. <br /> declare that this application (including any accompanying schedule) ha been examined me d to the best of my _ w ' A <br /> Gc C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of o, c ? : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CJ <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. fD o <br /> SIGN HEREPiYti✓�O.fsr'! L� ! a <br /> (signatur ner or building contr tor) (date) <br /> ZONING ADMINISTRATOR *, 'A 69 <br /> N <br /> C> N N N N O O <br /> T O U N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />