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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> " <br /> 0 <br /> " <br /> CD <br /> OWNER J`1 V"\ e,S I 1 Vl Cl4 TELEPHONE , D h( <br /> S- - J 0C) I v <br /> m <br /> MAILING ADDRESS <br /> 75Lo LKoon! GANG <br /> 0 <br /> _ <br /> ( 0 <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) / �iG3/ ct_ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 1 Cn <br /> TYPE OF PERMIT(S): v ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION '❑I Q �/ C'uYf a <br /> STRUCTURE/ADDITION USE: G 4 T�q O 1 1'0 tT o As 1 O /` 3� J <br /> (Home/C�;Commercial Business; Bedroom, Deck;etc.) rn <br /> d <br /> BUILDING CONTRACTOR: S C- <br /> I m <br /> CD <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. T <br /> O <br /> � O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N o <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. a <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. <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. o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN O <br /> NEEDED. ^C^ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <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 X0 r a v a v v <br /> s. <br /> garage/storage only. Not to be used for human / �� � CD N ' n 0 a m <br /> habitation. l;. 3 n „ a <br /> /09` " 0 0 : 0 3 <br /> 7. o a 0 <br /> d m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d v+ <br /> CL v .� <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize CD O : m <br /> that this information I am providing will be relied upon b the County of Burnett Wisconsin in determining whether to is \ v <br /> P 9 P Y tY 9 ��) ' <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 f m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 1 0 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ° o <br /> ID <br /> CD m <br /> SIGN HERE Q a <br /> ,nature=or building co ct ) (date) <br /> ChiZONING ADMINISTRATOR ' <br /> fA EA fA�N <br /> N J N N O O <br /> O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />