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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator 1 -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> / + TELEPHONE 95 Z— 36 1-"S-7 ���Il O U <br /> OWNER L <br /> �OLW TJ to <br /> MAILINGADDRESS 8070 <br /> m <br /> PROPERTYADDRESS Z9701 &kjt-3t�NA (-Difkoi t/FS/VAjF-y ,O I <br /> w �� Tows <br /> c <br /> LEGAL DESCRIPTION(see tax receipt) 5 5tY-17 J 5+ T4l/J R���nl of M1,5 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION c'a <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <. <br /> N <br /> STRUCTURE/ADDITIONOSE: ' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> 2. <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> ?I o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Zo <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 O <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS �• a t <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O � I <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC71, <br /> ONE WHEN ° Ul <br /> NEEDED. <br /> 5t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. � c ) <br /> CONDITIONS OF PERMIT: / d <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE�i1 �� �� � �q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE V,F <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY `O�Coj f S lJ <br /> NDN Nay Z- <br /> 4. NO STI UCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. C)r- > > <br /> �� This structure to be used as private residential 3a 00 9 n M <br /> 6. garage/storage only. Not to be used for human m y y <br /> habitation. z N ° <br /> 21 <br /> o , ; <br /> At <br /> 7. _ At <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my {j 2 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E rn <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 Q <br /> providing in this applica on. I agree to permit county officia s charged <br /> ' with administering county ordinances or other N <br /> authorized person to cress to the abo ribed pr !sea at any reasonable time for the purpose of Inspection. m o <br /> CD m <br /> m <br /> SIGN HERE V o <br /> (signature o er or building co actor) (da a) <br /> ZONING ADMINISTRATOR <br /> AcdUq <br /> v` �(1 TOWNSHIP PERMITS MAY BE REQUIRED _ I <br /> HIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />