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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ^ r <br /> �1 t7�• n^7� ,-1 V/ T `7`s--/8�� ,�J�S` '7 C o <br /> OWNER (©I'sL:R / 1A O~ S C. / �SJ PHONE / (� � / � E_ <br /> o �: <br /> O <br /> MAILINGADDRESS <br /> r <br /> o <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax r ceipt) U <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ rn o <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION El a <br /> STRUCTURE/ADDITION USE: R V D iTI O N 70 EX J T�,✓ LT//►V/y o <br /> // C (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) c <br /> cA <br /> BUILDING CONTRACTOR: )54/ 7 <br /> ° 3 In <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD <br /> TO 3 � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. h <br /> 7 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> MO Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v V) 30 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH( ) 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m (\3 <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. t N ' 3 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 On <br /> MUST BE SIGNED AND DATED BY THE OWNER. f t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° \ <br /> NEEDED. \ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT d <br /> ISSUANCE. W C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 0 lJ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING;WAI IS FTC Al I OWFn WITHIN THF RFOI IIRF:n WATFR <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> m0) M0onom <br /> 6 habitation. ; F 3 a m r °' m A <br /> a om <br /> 0C: o 3 <br /> 7. <br /> Cn m <br /> I declare that this application (including an accompanyingscneouie nas been examined b me and to the best of m — in O <br /> PP ( 9 Y I Y Y G>� -4 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m' 0_ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mc m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C� cn <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 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reaso pe ion. m 'o <br /> -n <br /> CD aCD <br /> SIGN HERE <br /> a re of owner bui ding contractor) (date) o i <br /> qM� I � . <br /> ZONING ADMINISTRATOR .i 200A <br /> `�in in vi C9` N <br /> IaTHIS <br /> TOWNSHIP PERMITS MAYBE REQUIREBURNETT COUNTY <br /> ERT SHALL EXPIRE ONE YEAR FROM DATE OF ISSZ�ANG <br />