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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> J uNi O <br /> OWNER 9a `t-/ ' •Qr /V �/ D��j Son TELEPHONE6p� <br /> HOME ADDRESSq07 s �� S-{- (� f lYl f -5U(r, 3 v 1 <br /> by <br /> EMERGENCY/FIRE NUMBER ROAD NAME LaKe� � 7'rdil <br /> {7 <br /> LEGAL DESCRIPTION (see tax receipt) L9 CJ (/n 6 f�aQ m <br /> p� V / m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ rn 0-- <br /> TYPE <br /> TYPE OF PERMIT(S): ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n ' <br /> STRUCTURE/ADDITION USE: 0 <br /> (Ho /Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: 1306 ./ y n644 <br /> v <br /> V1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 M <br /> CL <br /> 7 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn ° ",Z) n <br /> NORTH(N). y c <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. 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. 0- <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS Od <br /> MUST BE SIGNED AND DATED BY THE OWNER. o t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q 0 _ <br /> NEEDED. <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. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE P"^'AMn I inn Fcc RPFCIFICALLY ^ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, This structure to be used as private lF► <br /> SETBACK AREA. residential garage storage only. Not to be <br /> 5. <br /> used for human habitation. dd g.0 <br /> CL Im <br /> 6. 3 a m P7 <br /> N N <br /> /1CD <br /> 7. s fe JQ�j a re�a ra h Ja7��jj �n/rfir r le%`/be/ UXes <br /> I declare that is a li ion (including an accompanyingschedule has b en examined b me and to the best of m m <br /> PP 9 ) y Y L7 C p <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 m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- l7 <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 m <br /> authorized person to have access the above described premises at any reasonable time for the purpose of inspection. T <br /> J�J <br /> m <br /> SIGN HERE ���—a 0 0 <br /> slg re of owner din tr r (date) <br /> ZONING ADMINISTRATOR — • • • • . Fn <br /> 4�40 40" <br /> N N(A NN (nM <br /> (n to O fT N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED -.0 0 0 0 0 0 0 <br />