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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator �' �0 o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> m IR <br /> .�rp <br /> OWNER <br /> A <br /> TELEPHONE f Lr:F-! 7 <br /> :n Odd <br /> HOME ADDRESS /!� ! f L) T S�j U^Q f/t e w Ml ey <br /> r � <br /> EMERGENCY/FIRE NUMBER 4 / ROAD NAME t�Qti'vW At - 2� _ to <br /> uT Yo[" /-V Vvktf orI?Laf1 Py lqo <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 40 d G e3-I-D?f"I a S iQu iJba l�l ID <br /> a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ 1 Cn <br /> TYPE OF PERMIT(S): O `c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> N <br /> STRUCTURE/ADDITION USE: Gt 4 rN 4q �e— D 0 <br /> (Home/Cabin; Commer dal Business; Bedroom; Deck;etc.) Cn <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/]X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Oin o <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m n <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 ria <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. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <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 Q' <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 ° <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: G <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. <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.5. 2' /2 ' ��'Q� �75 P <br /> 6 �j ` This structure to be used as private residential 3 n N a <br /> V / garage/storage only. Not to be used for human 9 y H o : ° 3 <br /> Z m -� <br /> 7. habitation. o =?I :0 <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m 4 C <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 of 1' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize f m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to isIG <br /> - <br /> sue a permit. I further accept all liability which may be a result of the oof Burnett relying on this information I am m <br /> Providing m this application. I agree to Permit county officials char <br /> nn ounty ordinances or other m <br /> authorized person to have access to the above described premises at Ietilri t s of inspection. m ; E <br /> i <br /> u r m <br /> SIGN HERE <br /> (sig �I <br /> nal of wn r or building contr r) L CU/1y ( ) '• �}. <br /> U' <br /> ZONING ADMINISTRATOR <br /> � N Nt�71 <br /> 77�� COUNTY <br /> TOW SHIP PERMITS MAY BE REQ64L218IN(G ��� �� o 0 0 <br />