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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 <br /> Office of APPLICATION FOR LAND USE PERMITS Hing Administrator M 0 0 <br /> 3 < <br /> r- <br /> a 0 <br /> ovlrtvER Sew -� <br /> TELEP 7!s'— �Z n <br /> v <br /> MAILING ADDRESS �� m <br /> PROPERTYADDRESS 5/ \ o fD <br /> d� <br /> T w%x vf' fare.�sC o, OuY rtG71„1` ! f� <br /> LEGAL DESCRIPTION(see tax receipt) <br /> d el0 GO , rn <br /> DWELLING/BUILDING ❑ w CD (� <br /> TYPE OF PERMIT(S): GARAGE/ACCESSORY STRUCTURE � l?L <br /> ADDITION ❑ o <br /> FILLING/GRADING ❑ c <br /> CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: / <br /> (Home/Cabin; mercial Business; Bedroom; Deck;etc.) c <br /> BUILDING CONTRACTOR: <br /> m <br /> io <br /> 4 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR D <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) N lc>c <br /> CD <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE Z <br /> NORTH(N). m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v 3 <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK T(ST)AND DLAND ARAINFIELD(DF),AND ALL DISTANCES TO <br /> S. <br /> BUILDINGS,ROADS, LAKE, LOT LINES. o <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRA ~ O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER) GLEr '�" <br /> MUST BE SIGNED AND DATED BY THE OWNER. ER, <br /> �0.�y! <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VES <br /> NEEDED. ICATI �=J <br /> J �11�4Y�B3DONE WHE i o t n� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: BUR 11'�CODA'T� / (� 1 n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT N ,Y r r 'I I <br /> ISSUANCE. O Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. UP <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. p� <br /> Y <br /> 5. <br /> This structure to be used as private residential <br /> 6. garage/storage only. Not to be used for human C W W D o a v <br /> CD d d > m a <br /> habitation. in' 3 'o.00 x n m <br /> 7. 'O (D C yZ0 to <br /> y p 3 <br /> N <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my o y T� 1J <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 I further declare that I recognize a =: m o . C <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in r to is- (D O <br /> determining whethe <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. 1 agree to permit county officials charged with administering county ordinances or other O <br /> m <br /> authorized person to have cess to the above described premises at any reasonable time for the purpose of inspection. m <br /> m . <br /> SIGN HERE c/ <br /> T : 0 <br /> ® to m <br /> qt ow r buildin c ract n <br /> (date) <br /> ZONING ADMINISTRATOR <br /> HifA ER fA�N <br /> TOWNSHIP PE MITS �73o n1 <br /> MAY BE REQUIRED t N o ul 01 0 00 <br /> Flo <br />