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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 US R T1T 3 = <br /> � TELEPHONE 0 <br /> OWNER IJ ✓�/�Z ,Q. S�ir�fl✓fl�G)1</�� 7fs—��v6' '7� — o \ <br /> O <br /> HOME ADDRESS <br /> 0 <br /> EMERGENCY/FIRE NUMBER a?gglD ROAD NAME 5 � fYf.>0 D <br /> f m3 �sw /�e1W oI1 <br /> LEGAL DESCRIPTION(see tax receipt)a_/��_��^ O7r� 4fr78DG f C_d�l (Ism 't/(9 R S$ 1" 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION E:1 PRIVY ❑ <br /> U) ° <br /> v <br /> TYPE OF PERMIT(S): ❑ SUBDIVISION ❑ a <br /> FILLING/GRADING ❑ CAMPING UNIT <br /> �Y �, o� is x ° <br /> STRUCTURE/ADDITION USE: 5'/ O�A/r ' <br /> (Home/Cabin; Commercial Business; Bedroom, Deck, etc.) 0 <br /> v, <br /> BUILDING CONTRACTOR: •2 f <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN BYE X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> >tl m O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> M m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). m ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE 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 o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> b <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO �4 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. �J <br /> S TO BE GRADED OR FILLED. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREA0 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS �. I <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° ° <br /> o <br /> DOWHEN0 ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUS' BE STAKED SO AN ONSITE VERIFICAT NE <br /> 01 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. / wl o I <br /> CONDITIONS OF PERMIT: (•4f <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER�A,n S 2 O1 <br /> ISSUANCE. �, D� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINF� C <br /> 3. NO GRADING,OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLYPEM �/`/�A,G�Gr� <br /> 4. NO SIRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATYER <br /> T <br /> SETBACK AREA <br /> A � C) r DCDO '9 <br /> 6. This structure to be used as private residential '5m = v °i 0 CD a f m <br /> garage/storage only. Not to be used for human c y " <br /> 6. ° <br /> habitation. o : y m <br /> 7. - � <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my n C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- I <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 /> m : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> CD <br /> SIGN HERE 1 — <br /> (signature of owner or building n actor) i (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />