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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. 9 <br /> - r <br /> i, o <br /> ` N <br /> OWNER rJ/ / l G �'/,� / Sp /J � TELEPHONE 7!✓ ] — 2 �Q -Z <br /> n j�/ /Q2 <br /> HOME ADDRESS V:5b 9 / C X� 9d �� ' r�/�/ (C I u{/ x(11 J/7 <br /> r � <br /> EMERGENCY/FIRE NUMBER 6 L ROAD NAME�� � ` r <br /> //c/ CSS► � / "�-��-/8 <br /> LEGAL DESCRIPTION (see tax receipt) ��' V // P � 7 �� rjd v ,G B m <br /> / m <br /> I v <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ ` rn <br /> TYPE OF PERMIT(S): Q ' <br /> FILLING/GRADING CAMPI G UNI SUBDIVISION ❑ UI a <br /> aaxayS. <br /> STRUCTURE/ADDITION USE: Q G T <br /> o �. <br /> ome/Cabin Commercial Business; Bedroom; D66;etc.) m n <br /> BUILDING CONTRACTOR: <br /> v <br /> nr <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 - <br /> O = <br /> I'tl N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. i7 m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 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. 9Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N Com, <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONT? C.,THE PLANS ) 8. <br /> MUST BE SIGNED AND DATED BY THE OWNER. �r ,� o <br /> � v'7o , <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC;TION MAY B 0 <br /> NEEDED. FEBT <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. le 7 21703 0 �f <br /> CONDITIONS OF FERMIT: a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT "01VI OUN7Y <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 6 <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 l7 <br /> SETBACK AREA. <br /> 5. <br /> X m m <br /> L <br /> m <br /> This structure to be used as private residential $ a F g z <br /> 6. garage/storage only. Not to be used for human a c H m7. os 3 <br /> habitation. Z : y m <br /> o : <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ; o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize M <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �: O <br /> G <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 m <br /> authorized person to have access tthe ove described pre ises at any reasonable time for the purpose of inspection. -n <br /> CIO : <br /> MSIGN HERE <br /> � 03 <br /> (signature of r or b ng t � (date) <br /> 8 12,c� : <br /> ZONING ADMINISTRATOR o "— fn <br /> (Z0 40 cn vi fn <br /> N N NN (ntn <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o o 0 0 <br />