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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrato0 <br /> o <br /> APPLICATION FOR LAND USE PERMITS pyo' 3. <br /> 7/Z yP Y a 07440/}[.er M'•v 5S-/z8 G Sl 7775/8 9 <br /> OWNER l TELEPHONE ,/5 F/lee <br /> � 7� <br /> HOME ADDRESS 7Z il '7 S'7& r Ale vr, 57 4/£3 o v <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME ) <br /> LEGAL DESCRIPTION(see tax receipt) 04K i/_ oT ���( � sfJ L m <br /> DWELLING/BUILDING ❑ BARAGE/ACCESSORY STRUCTURE fR ADDITION ❑ PRIVY ❑ 0 <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ 5_ <br /> N. <br /> STRUCTURE/ADDITION USE: -rZA4a 9 3 tv X 46 j / <br /> (Home/Cabin; Commercial usiness; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: Q V A L�Tit/ OSI<ST�L r (?f? tv <br /> M <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. 0r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o O <br /> T o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m 'b <br /> 2 .SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. 'o c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Ct <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n Q] <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 /> SET BA A A. ILf [ D <br /> This structure to be used as private residential ma y w Q- z <br /> 6. / 'LX�t� m c m o = 3 <br /> garage/storage only. Not to be used for human — <br /> 7. habitation. o <br /> _ c, : z <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m c p <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofn 0 C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am provi ill be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accpdaioability which may be a result of the County of Burnett relying on this information I am <br /> providing in this applic o agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to av cess to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> m : <br /> '7 <br /> SIGN HERE ./ ::z o <br /> signal re f owner or buil g contractor) (date) <br /> ZONING ADMINISTRAT <br /> 'A fn fn v+<n tn� <br /> N N (nNN (n fT <br /> N N O N V O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />