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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 /> V <br /> �� SAI t'1. � ,f� � A/l 11 <br /> OWNER 1l'�/��� "t.%' il.�#`�+ �r CI v TELEPHONE o rl <br /> w <br /> MAILING ADDRESSCD <br /> CD <br /> PROPERTY ADDRESS = f 2-19 e4 o <br /> vl <br /> LEGAL DESCRIPTION(see tax receipt) Q <br /> y 1 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ {�,''' In o <br /> TYPE OF PERMIT(S): lJ� or <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �: <br /> STRUCTURE/ADDITIONOSE: <br /> lb �77yY� <br /> ome/Cabin; Commercial Business;Bedroom;Deck;etc.) cn �l <br /> BUILDING CONTRACTOR: bAc 6 J � m <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 17 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 p. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> M y S <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) 3 <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. ° <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. tXCJ.' <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 j, o ' <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v � W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. = �, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY d <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. This structure to be used as private residential <br /> ;;a 0 r'>ODOR <br /> g, garage/storage only. Not to be used for human ); 3 R m �a <br /> habitation. z ° o H = 3 <br /> 7. o 'n m <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my Lj c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of R n F» <br /> C, �n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ; : O mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. CD <br /> - o : <br /> (D <br /> SIGN HERE f} a <br /> t <br /> t re of o n or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> fA(M fA fA�N <br /> N (T N N O O <br /> (T O(T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />