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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS5T 0 <br /> 3. <br /> OWNER �� t(, �Ln�_1 TELEPHONE �_ �' _ 19 `� n <br /> HOME ADDRESS q11 Ill} & Noe, � l� `J 6 � � N� � J ��Y 0 <br /> / t o <br /> EMERGENCY/FIRE NUMBER a4 ROAD NAME' <br /> LEGAL DESCRIPTION(see tax receipt) n G4 p <br /> 6 J1 y <br /> CD <br /> DWELLING/BUILDING ,GARAGE/ CESSORY STRUCTURE ADDITION ❑ PRIVY ElCn <br /> 0 <br /> TYPE OF PERMIT(S): X� Q <br /> FILLING/GRADING 1:1 CAMPING UNIT El SUBDIVISION El Q9 3fitf a <br /> STRUCTURE/ADDITION USE: C `� 15 <br /> (Home Cabin; Com ercial Business; edroom; eck;etc.) rn C <br /> BUILDING CONTRACTOR: Er ice_ <br /> v <br /> g; <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR OT 3 ` <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O min <br /> T n <br /> Z <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). c 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ` 3 n` <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. o <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. n <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Jv <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0 A <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> _o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VH m <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z I <br /> CONDITIONS OF PERMIT: OCT 2OV c Z!-.1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAW OF PERMIT L <br /> ISSUANCE. BURNETT COUNTY <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREL26NING <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. <br /> This structure to be used as private residential X v d w � O m <br /> 6• garage/storage only. Not to be used for human 5 3 n`° �e� E <br /> habitation. Z N ; 9 =i <br /> 7. o ;a <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (j ID <br /> m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m . <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (� O <br /> I <br /> sue a permit. 1 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 applicati 1 agree to permit county officials charged with administering county ordinances or other m E <br /> authorized person to have k_cdps to the above described premises at any reasonable time for the purpose of inspection. CD <br /> m <br /> II h J� <br /> SIGN HERE � <br /> (sIgTn!tLurA of ovin or building contractor) (ddte <br /> ZONING ADMINISTRATOR <br /> f»fn tnwwtn� <br /> bnCNnocNioioo <br /> TOWNSHIP PERMITS MAY BE REQUIRED °0 00000 <br />