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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator w o Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> �r c� <br /> OWNERAf TELEPHONE o <br /> 0 <br /> MAILINGADDRESS , 4 IO -/ 40 <br /> Dun J <br /> PROPERTY ADDRESS _ <br /> DD <br /> LEGAL DESCRIPTION(see lax receipt) 0 ca (� <br /> DWELUNG/BUILIDING ❑ GARAGEIACCESSDRVSIHUCIURE ADDITION ❑ v U> > \�' <br /> TYPE OF PERMIT(St <br /> FILLINGIGRADODI/ tr tiAII'N__3 El UNIT Ll SUBDIVISION El - <br /> STRUCTUREIADDITIONUSE: r — 16 n Fh) /Q^,,W- or) - <br /> ( omelCabin; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR'. <br /> y <br /> A PLOT PLAN MUST BE PROVIDED O 4 AT LEAST AN BY:%11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL <br /> BE RE rURNIcu O wDzz <br /> F <br /> UIRECI19bla FOR PLOT PLAN DRAWING. (AERIAL OR TOP VIEW) O n <br /> T <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O o A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NS)AND INDICATE m A <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF rHE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF z <br /> LAKE,STREAM OR RIVER AND h EASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE A ELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE,LOT ANES. `e <br /> 5. INDICATE IF A WALKOUT BASEh ENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ) S <br /> 6. IF SEPARATE PLANS ARE SUBM TTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED B THE OWNER. <br /> a H <br /> NOTE: NGISTRUCTURE LOC TIONS MUST 8E STAKED 50 AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. r <br /> NEEOEO. n- <br /> V) <br /> THIS PERMIT IS SUBJECT TO ALL CO ADITIONS LISTED BELOW <br /> O . o <br /> CONDITIONS OF PERMIT: <br /> 0 <br /> 1. DRIVEWAY MUST MEET ORIVEW kY WIDTH REQUIREMENTS WITHIN 50 DAYS OF PERMIT ` <br /> ISSUANCE. <br /> 2 REMOVAL CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADINGG OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY � a <br /> PERMITTED. O <br /> 4. NO STRUCTURES. INCLUDING RIETAININO,WAI I S FTC Al I nWPD WITHIN THE REQUIRED WATER <br /> SETBACK AREA. This structure t0 be used as Private residential <br /> 5. garagetstorage only. Not to be used for human p wn u n o n o <br /> 6, habitation. m x 3 A <br /> ado : <br /> 7. o . at— a <br /> 1 declare that this application (Includ an any accompanying sensors) ties Dean examinto try me ane to om oast of my m <br /> 2 C <br /> knowledge and belief it is true,corre t and complete. I acknowledge that I am responsible for the detail and accuracy ofSt '^ <br /> all information contained In this appll ation(Including any accompanying schedule)and I further declare that I recognize c p <br /> that this information I am providing 1 ll be relied upon by the County of Burnett Wisconsin In determining whether to is- to. <br /> sue a permit. I further accept all list try which may be a result of the County of Burnett relying on this information 1 am o' <br /> providing In this application. I agrei to permit county officials charged with administering county ordinances or other <br /> in <br /> aulhorixed person to have access to is above described premises at any reasonable time for the purpose of Inspection. <br /> m <br /> SIGN HERE / 6 D IS, <br /> (signet.r of ow.Tor build g contractor) (e ) <br /> ZONING ADMINISTRATOR V I <br /> T WNSHIP PERMITS MAY BE REQUIRED <br /> T S PERMIT HALL XPIRE ONE Y AR FR <br /> Kra <br /> M DjE OF ISSUANCE <br /> a�m1} (elCl Pfck ctP ybr�t nz <br /> g 7lg�b <br />