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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER /U i'�0� TELEPHONE � � <'`�6 f <br /> a W <br /> MAILING ADDRESS C � ' O <br /> PROPERTY ADDRESS �G <br /> A <br /> LEGAL DESCRIPTION(see tax receipt) SCS, �tt1— L1 �� ©! yD O <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ADDITION � <br /> ❑ 3. N <br /> TYPE OF PERMIT(S): � 4 <br /> c <br /> Q <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ ,/ /) � <br /> STRUCTURE/ADDITION USE: `d y� I X (/ o h Q <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) /1 U) �1 <br /> ,t� e <br /> BUILDING CONTRACTOR: <br /> S� <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 0 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O 3 $ <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) c <br /> OT a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m O A <br /> m m <br /> NORTH(N). c n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m (� 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <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. C3 <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 0 pJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o o <br /> QJ <br /> NEEDED. w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> t <br /> CONDITIONS OF PERMIT: o ` p <br /> W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � <br /> ISSUANCE. v) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Gi C <br /> PERMITTED. v1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WAI IS FTC A[I OWFD WITHIN THE RFOUIRED WATER <br /> 5. SETBACK AREA. This structure to be used as private residential <br /> garage/storage only. Not to be used for human ; m v r > o D o M <br /> 6. habitation. s 3 a CD a w <br /> pm CN . o � 3 <br /> 7. Z c in m o <br /> Wim : <br /> P m <br /> I declare that this application (including any accompanying scneoule) nas Deen exammea oy me ana to the pest of my ° A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m c e C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognizem E m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m I CO <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information 1 am i i i d' o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person a access to thea ov described premises at any reasona 1 c n. m <br /> n <br /> SIGN HERE (D a <br /> to a <br /> i ature of ow r r building contractor) T� (date) <br /> j <br /> ZONING ADMINISTRATOR APR 6 CW5 ' <br /> O O N'A W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIREDBURNETT COUNTY o �^ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSIA@MG <br /> nC(TiV'd +o �Depo'S San lat�11(•�ar �/-[� Z1S <br />