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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. � °� <br /> N 4 <br /> N Q <br /> OWNER TELEPHONE <br /> u S G f TELEPHONE 6S <br /> MAILINGADDRESS 42 -2 6sTelli; rJ p,QSA2&-viEw/ �/(/ �S^�Z/ � f <br /> nQ � 9 b � m <br /> PROPERTYADDRESS / 7� /JoN�y Z-K ��, 1�o0 otg /&"q <br /> SL(O b I o <br /> III` <br /> LEGAL DESCRIPTION(see tax receipt) 5 4 -U f4 60 ( „ O�l7 G J,-3 � i <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE V ADDITION ❑ N o' <br /> TYPE OF PERMIT(S): c = <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a�x3� a <br /> STRUCTURE/ADDITION USE: PDS T rr< &7g <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: fl/,C{6 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n - <br /> �I H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p d <br /> n a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> i7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 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 t 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. o <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 0 CO <br /> MUST BE SIGNED AND DATED BY THE OWNER. o { <br /> 0 <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. — <br /> � ( LI III <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 PE�MIT Aan ZOU3 <br /> ISSUANCE. R w <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORINE. <br /> 3 NO GR <br /> TDIN OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALL 13WI( �" COUNV <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATW N o <br /> SETBACK AREA. <br /> 5, K This structure to be used as private residential m unirtD� ( M <br /> aO <br /> 6. '\S garage/storage only. Not to be used for human g 3 a g � n � <br /> habitation. -a c N " o M <br /> 7. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m v+ C <br /> CL v <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to isCD <br /> - <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m c <br /> mo: <br /> m m <br /> SIGN HERE 3 o/63 <br /> CL : <br /> (signature ofow r o building contractor ( ate) p <br /> ZONING ADMINISTRATOR (t / <br /> EA fR lfl di�+N <br /> N(T N N O O <br /> Ill U <br /> TOWNSHIP PERMITS MAYBE REQUIRED C" OM OO$_ �f <br />