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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administratoro 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> N <br /> � p el <br /> OWNER /` C �/� �Q��a eTELEPHONE <br /> HOME ADDRESS / O <br /> lc t 44-le bee- �� 5'�"i z� 9 <br /> CD <br /> f s <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) L � C � t1 ti <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ "L W <br /> TYPE OF PERMIT(S): C�JJ Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ LS. <br /> \ r <br /> STRUCTURE/ADDITION USE: Gar^aq� / O , O e U /� c3(P o' <br /> ( ome/Cabin; Comabircial Business; Bedroom; Deck;etc.) m <br /> I <br /> d <br /> BUILDING CONTRACTOR: (Zr+ �{1/ 16A nA ai/ PAfiat <br /> T <br /> 1 <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. <br /> :0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. M" m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AN61�l�l1CATE <br /> NORTH(N). C `1' n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m D3 <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. M <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS W <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o �p� <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. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. Ji <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 M M d o o v <br /> 6. garage/storage only. Not to be used for human gmaCL <br /> 93 <br /> habitation. <br /> 7. Z : 1" m� <br /> o : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �+ <br /> all information contained in this application(including any accompanying schedule)and 1 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- O <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 to the above described premises at any reasonable time for the purpose of Inspection. m <br /> nr <br /> SIGN HERE./ /a4i.c�. <br /> (signature of ow r or b ilding n ctor) / (date)^, �}} <br /> ZONING ADMINISTRATOR `/c729'�J V!i <br /> Fn N0Nto0Ln <br /> I �pN N U 1 N N f T V 1 <br /> TO NSHIP PERMITS MAY BE REQUIRED I�`Q`f�r �J 0 0 0 0 0 0 0 <br /> �G <br />