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ON COMPUTER/SCANNED <br /> Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator - o c <br /> APPLICATION FOR LAND USE PERMITS <br /> N O <br /> N <br /> /� C <br /> OWNER Z/ TELEPHONt 7 L/ r <br /> 'nf QCT m „ ` <br /> MAILING ADDRESS t'`�fbS* uk �V -3 v 1 J <br /> PROPERTY ADDRESS <br /> A0 - 3q-1b <br /> LEGAL DESCRIPTION(see tax receipt) liv <br /> ( {�/t/� L <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE fJ ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): g <br /> FILLING/GRADING ❑ 9AMPING U IT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: y " o <br /> (Home/Cabin; mercial Business; Bedroom; Deck;etc.) ro <br /> BUILDING CONTRACTOR: <br /> 7 � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/s X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) a (it'' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m Ov�o fO <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn chl4 <br /> 3 <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ( ° <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c <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. ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> I <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 PERMIT <br /> ISSUANCE. (� ( 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <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. / (-�yH This structure to be used as private residential 9 o r D O D o 10 <br /> garage/storage only. Not to be used for human m 3 m % T M <br /> 6. habitation. " m c y y o 3 <br /> 7. o %i c <br /> c CD O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my c i i C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of pp a» <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 1C J m m ? c <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ; <br /> sue a permit. I fu her accept liability which may be a result of the County of Burnett relying on this Information I am <br /> providin t s a plication. agree to it coun o ials charged with administering county ordinances or other CO c <br /> m : m E <br /> authors r on hav o the ov desc r mixes at any reasonable time for the purpose of Inspection. -n c <br /> SIGN HERE <br /> Wi n J of owner rJ building contractor) (date) ° <br /> ZONING ADMINISTRATOR l J� Ml Qn 1 ay) <br /> N(011 1� 0 <br /> (A O CA({li fit O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />