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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS 1e � 3. <br /> r <br /> N O <br /> N <br /> Ld v <br /> OWNER �e rm 2 r/v, T �c7 c H�t L- TELEPHONE&.S 1-7,3 r/ -J ft 7 % I <br /> MAILING ADDRESS 7/k3 7 ���r_ pylD9l .��9h .5 �dL� <br /> r <br /> PROPERTY ADDRESS c;? 77(�,� <br /> LEGAL DESCRIPTION(see tax receipt) L 1.-�rY� � y <br /> M <br /> �y <br /> DWELLING/BUILDING ❑ GARAGE/A CESSORY STRUCTURE .LSI ADDITION ❑ y 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITIONUSE: GR 2� �� �.(\� —C`� o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) rn 19 <br /> d <br /> BUILDING CONTRACTOR: S e L F <br /> Z � <br /> v <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. T 3 <br /> M m -� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m C <br /> T n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C) � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). <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 <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. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS ( 0 g J <br /> MUST BE SIGNED AND DATED BY THE OWNER. 5 i <br /> Q�; o0 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0. O <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a A <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q C>' <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 6� V <br /> PERMITTED. (G� <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> (v�6. sJl�r�,, ; 'M/ This structure to be used as private residential x 0 d > o Q F m <br /> �@� garage/storage only. Not to be used for human $. <br /> 3 a m x° m <br /> m D�L(hY) Of lQ habitation. z y m o 20 3 <br /> ;a <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m 0 0 <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ui CD <br /> 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 a d <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m = <br /> mo : <br /> m m <br /> SIGN HERE J--d 7 <br /> a : <br /> si u of owner or buildin tractor) (date) <br /> t <br /> ZONING ADMINISTRATOR <br /> Ni0 `jI <br /> M 0 0 <br /> 0N <br /> N <br /> 0 O <br /> NN(TO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />