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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator _0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> s <br /> 4 <br /> J/n J <br /> OWNER <br /> LQ C-t� S �. / �/�f P/ TELEPHONE � �,Ej — � LI P5' v <br /> q O <br /> MAILINGADDRESS b �� ��t rf /�P <br /> 0 <br /> PROPERTYADDRESS fQ M"::2 <br /> S L o J3 Ttr/ . 4-(/ 33 c7 r w66o ' <br /> Lo t / E x Th aY Pew- tp,-y ofC o-4- T k r <br /> LEGAL DESCRIPTION(see tax receipt) !t/ L P ' o S /�t // J I U <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ fA O <br /> TYPE OF PERMIT(S): `v <br /> FILLING/GRADING ❑pCAMPING UNIT i❑, SUBDIVISION <br /> / ❑ n <br /> STRUCTURE/ADDITION USE: v a r et ,c l �``r ]` o <br /> (Ho a/Cabin;Com ercial Qusiness;Bedroom;peck;etc.) <br /> BUILDING CONTRACTOR: J if �P^ 'rte <br /> v <br /> M <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. OT m <br /> M n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n ~ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). CO) o <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 c <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 /> 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <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. q4-2yj This structure to be used as private residential r a v r v v <br /> 6. <br /> s. garage/storage only. Not to be used for human " d ° ° `D a f m <br /> �+ MO yam <br /> habitation. W c y ^ o 3 <br /> 7. w <br /> Z 4 <br /> o 4i`2 <br /> m <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my �j C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeC ji o G <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 further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I 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. fD C <br /> _7- <br /> m m <br /> SIGN HE <br /> (signature of owner �ding contractor. / (date) 1� n <br /> ZONING ADMINISTRATOR <br /> M EA K)fA0 N <br /> NN0 NN 00 <br /> *-� O(T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED *7S <br /> 01 ti--y(-/ <br />