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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -VQ z <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> • /force Cola `y3� -7�S 3 y <br /> U-)c'A'N 0.,61 - 3io-?SS <br /> OWNERrx r• TELEPHOtSCQ•b,,, / <br /> m <br /> HOME ADDRESS -� =° O <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> KS- 9 3Oy S'ga' 1 � <br /> LEGAL DESCRIPTION(see tax receipt) 67 ` V0—q0-&>-0 O ;ZS-00 <br /> O ✓c 0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X1 ADDITION ❑ PRIW ❑ k c(po <br /> TYPE OF PERMIT(S): <br /> 1 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ e CL 7C <br /> STRUCTURE/ADDITION USE: GQrp-ne, J S)LorfLOP <br /> c n Home/Cabin, Comm ial Business; B roam; Deck;etc.) y <br /> BUILDING CONTRACTOR: St- 11' ?. <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. m _ <br /> O = <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) <br /> O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m U z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 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. J c <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. i; <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 N d <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. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN �^ <br /> NEEDED. a S , <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o -91 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I }Cl <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. <br /> 5. This structure to be used as private residential <br /> garage/storage only. Not to be used for human X ' d d i 1�0 o v <br /> 6. 3aie3C - m <br /> habitation. m c 8 <br /> 7. z `" �� fi =t <br /> I declare that this applicat =q m <br /> Ind to the best of my 2 lo <br /> G <br /> knowledge and belief it is true, U11VUL G11Y bV111Fl1CLe. 1 Yb „ <br /> pVWIWUUW L„QL,Q,,, ff V ,VWINIIV.V.V. d <br /> ...G etail and accuracy of d C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> Wisconsin in determining whether to is p <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this inform <br /> that this information I am providing will be relied upon by the County of Burnett ation I am ei <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 /> m <br /> CD : <br /> SIGN HERE 8 d+ <br /> (s `��ure�of owner r bu dIng con ctor) <br /> ZONING ADMINISTRATOR <br /> to <br /> Nri to w M <br /> 5iloo0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0cn 0 0 <br />