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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 /> w o <br /> 34q-9-'4,56 <br /> OWNER ,TAMES L. J-0RDA0 TELEPHONEgS-,?. -8831 <br /> CD <br /> HOME ADDRESS �p <br /> �da3 (o CorrAGEWaoP RIP. <br /> O D <br /> EMERGENCY/FIRE NUMBER qq 3S ROAD NAME (3EICIFRAM 'RD. ~ <br /> y <br /> LEGAL DESCRIPTION(see tax receipt) $ 9/7B <br /> O /R 1$W $7/��3 Oa$Oo <br /> 41-39-IE;-07-0Pct_ (SO >^DT 8 1 <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIVY ❑ N 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: GARAGE. a LI N oy i 1 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) cn J <br /> m <br /> BUILDING CONTRACTOR: S e <br /> iu <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <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. <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 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> D � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ` <br /> 0 <br /> CONDITIONS OF PERMIT: nom\` <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ti 91 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 /> �KAREA.5. This structure to be used as private residential Q W CD r D o D O M <br /> 6. <br /> garage/storage only. Not to be used for human CD a X - <br /> habitation. y N o y g 3 <br /> 7. o ' -n <br /> - Cn : A <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my G>c e <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n T 55 <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize CD ; <br /> p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> 0 . <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 <br /> authorized person to have access to the above described remises at an reasonable time for the purpose of inspection. `D <br /> p P Y P P P -n <br /> 'D <br /> SIGN HERE <br /> � L-7 -01 <br /> ; <br /> ( gnat re of ner r b ding contractor) (date) ((� <br /> ZONING ADMINISTRATOR <br /> �lJ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />