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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator T °oo <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> I <br /> UT 0 <br /> OWNER LV/"///4,j4 'f-&rfj SI Ititos� TELEPHONE z5 GjOZ o <br /> m <br /> MAILINGADDRESS Z _73 (,y VVL k4 y p If i; / v r <br /> JJ__ 0 <br /> PROPERTYADDRESS ( , �q G��� S r R� _ I✓n Av.kl W� ~ <br /> , <br /> LEGAL DESCRIPTION(see tax receipt) cOVI� L b// Z SYS � <br /> � � Yr "t0 <br /> �� C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE K ADDITION ❑ rn 0 <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> X <br /> STRUCTURE/ADDITIONOSE: G k�r/.1--t -e- -1 <br /> � S D p-e-Lz/o o� �%` � <br /> (Home/Cabi ; Corfimercial Busin s; Bedroom; Deck;etc.) U) /h <br /> m <br /> BUILDING CONTRACTOR: i <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O a <br /> .ZI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). to ` 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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, CONTRAC`OR, ETC.,THE PLANS g Cori <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT N <br /> NEEDED. a _ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J NOV , o d <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMMI-I �2 <br /> ISSUANCE. Z <br /> co <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O/V(NG NTy f <br /> �✓ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING/RETAINING WALLS,ETC.,/ALLOWED WITHIN THE R QUIRED WATER <br /> �J ETBACK AREA / D / CA \ <br /> 6. This structure to be used as private residential ' 3 a m x a " ;a7, garage/storage only. Not to be used for human -a- <br /> N <br /> habitation. =cn m <br /> I declare that this , ,.. .._.. _.., _____.. ------- __..___. , been examined by me and to the best of my A <br /> W <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ` m O : <n <br /> y nc : vt : M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m O m <br /> that this information I am providing will be relied y the County of Burnett Wisconsin in determining whether to Is- <br /> sue a permit. 1 further accept alli <br /> ity whit ay e a result of the County of Burnett relying on this information I amproviding in this appiicatio I atop it my officials charged with administering county ordin nc or other authorized person to ccese o escribed premises at any reasonable time for the purpo o nspection. D o <br /> CDCD <br /> X SIGN HERE n <br /> Ng ure ner or building contras r ate) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS AY BE REQUIRED <br />