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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 /> r <br /> '/ <br /> C// <br /> ° o CEJ <br /> OWNER LG,.�„i YGw G! t� . _ �C -F� TELEPHONE e Q <br /> O <br /> MAILINGADDREAV 6yG '6Z /, 5IK S S13 <br /> 1-,ht A/o . <br /> PROPERTY ADDRESS 2 7 <br /> W <br /> LEGAL DESCRIPTION(see tax receipt) j <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ rn n <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <: <br /> STRUCTURElADDITION USE: 0 <br /> Home/Cabin; Commercial Business; Bedroom; Deck; etc.) C , <br /> BUILDING CONTRACTOR: yet v <br /> m � <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 _ <br /> A N Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> n �0 <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m a <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 IT a <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. b <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. �' e <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ' I.I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 09 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN c» o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ((0111 <br /> CONDITIONS OF PERMIT: P O <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY w I <br /> PERMITTED. `1 <br /> 4. NO STRUCTURES, INCLUDIN" ocTAlnunlr_rA/AI I R FM Al I nwFn WITHIN THE REQUIRED WATER f <br /> s. SETBACK AREA. This structure to be used as private residential <br /> garage/storage only. Not to be used for human X co 0 r > o a o v <br /> 0 > > 00 D;a <br /> 6. habitation. � F a - A <br /> omcN `.° o � 3 <br /> 7. Z c m CD ro .1 <br /> P m <br /> I declare that this application (including any accompanying scneaule) nas Deen examineu uy my dim to the best of my G) a <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of n, ' a 0 A <br /> all information contained in this application (including any accompanying schedule)and I further declare that 1 recognize `!✓ : m c 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 further accept all liability which may be a result of the Count r m ion I am d 0 : <br /> providing in this ap I' t' I agree to permit county officials charged will t i o n r other <br /> authorized person have access tot above descr'bed premises at any r p s ction. m a <br /> T <br /> CD <br /> a <br /> SIGN HERE <br /> igna a of owner b 'ding contractor) 11111111hate)MAI C + <br /> ((,^ <br /> ZONING ADMINISTRATOR GOUNv/ <br /> Vi (n <br /> ZONING <br /> fA <br /> ZONING © 0 " M W N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o w o cn v o <br /> THIS PERMIT SHALI.r EXPIRE ONE YJEAR FROM DAT9 OF ISSUANC <br /> ftyt W tk) =fh letKr -ho La AA _-- ch�� 5'-13 OS <br />