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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> OWNERA.P�fl✓/_l� jl �� /l>�>�I �'?F ['�f>�� TELEPHONE �pS�"�50 -/23 <br /> / d <br /> MAILING ADDRESS �(� fy l,,/ SrSGSrr pli 4.y A/Iy Q7 LJ O <br /> , <br /> 0 <br /> ym <br /> PROPERTYADDRESS 1/ 7 (� (� Ao21, <br /> )D 14lUe � t o <br /> LI S»-, V3 pay/ <br /> LEGAL DESCRIPTION(see tax receipt) �G r �f 7 Sv c Z7 3 7 1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 9 ADDITION ❑ rn o <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBD ISION ❑ o. ' <br /> STRUCTUREIADDITIONUSE: E ,tZ /7/' 3y X J o' Q 1 <br /> (Home/Cabin; Commercial Business; edroom;Deck;etc.) y <br /> w <br /> BUILDING CONTRACTOR: 6; r l '- <br /> m , <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 17 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> n a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. � <br /> n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. i <br /> o \ <br /> O II! <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ) <br /> CONDITIONS OF PERMIT: Q Q <br /> I. 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 <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 in >v a o v <br /> 6. garage/storage only. Not to be used for human s IO 3 cL ; a z <br /> 7. habitation. z y m c " 3 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 10 <br /> C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d o i v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information 1 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 1 am m <br /> providing in this applic ion. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person toKa4e access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m o : <br /> S z 3 dt3 <br /> SIGN HERE � <br /> a : <br /> ignature o ner or building co r ctor) (date) <br /> ZONING ADMINIST TOR <br /> fA 6A fA df�N <br /> I <br /> (TOUCTOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED l VVV CI NA' 1 <br />