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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator (D o° 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> OWNER TELEPHONE 'LJ V l7 I O <br /> o <br /> MAILING ADDRESS Z to ZSr G A8 <br /> r (R <br /> PROPERTY ADDRESS /+Z ed 1 - y <br /> 4 <br /> LEGAL DESCRIPTION(see tax receipt) S33 / <br /> o <br /> DWELLING/BUILDING [IGARAGEIACCESSORY STRUCTURE ® ADDITION ❑ U) = <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ N_W 4- <br /> STRUCTURE/ADDITION USE: T L <br /> S ►�ti - G A AAO` - Cn1 ca <br /> (HomelCabin; Commercial Business; Bedroom; Deck; etc.) � <br /> BUILDING CON TRACTOR: (��O 2 Y('4 LA NG 8014-6 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 �1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ;0 y CJ W <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n tr Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n F <br /> m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(N8)AND INDICATE � �- ` o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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. Y✓ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. p <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS =, - r <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN r. <br /> ° J <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° FS <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAININr,WA <br /> I c FTr. Al I f WFfI WITHIN THF RFrll IIRFfI WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. c d m 0 C a m M <br /> garage/storage only. Not to be used for human > ° ° a <br /> 6. habitation. -6, c y y 000 3 <br /> Z <br /> ° m <br /> 7. -'21 i m <br /> Id <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my ii G) c -4 ; C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy of ma <br /> all information contained in this application (including any accompanying schedule)and 1 further declare that I recognize <br /> ; m <br /> CD <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other j <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T n <br /> IJ D <br /> L m n <br /> — � 1- OS <br /> SIGN HER (date) ° <br /> (si atu of owner or building contractor) W <br /> ZONING ADMINISTRATOR <br /> C O N O CT 01 (T O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF I SBUM p <br /> UANCE <br />