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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 <br /> r <br /> F oCl) <br /> c <br /> rn <br /> _ a <br /> OWNER . TELEPHONE <br /> J . <br /> CDO <br /> MAILING ADDRESS ) <br /> 0 <br /> o <br /> PROPERTY ADDRESS <br /> Dr S'/ 1ZC" W/ .5`"V8 74�7- _ <br /> J <br /> LEGAL DESCRIPTION see tax receipt) 16 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE K ADDITION ❑ (n I <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION El <' <br /> Cn <br /> STRUCTURE/ADDITION USE: c q&r? 0 <br /> Jf (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) v <br /> BUILDING CONTRACTOR: S�° <br /> CDZ)A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR Z) <br /> -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p '", <br /> 70 n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a. <br /> T Z J <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS EB AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> t ) C <br /> NORTH(N). (a03 <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. <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,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. co 0 Ca <br /> 0 : <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: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. d <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RFTAININ(�WAI IR FT(' Al I oWFII WITHIN TNF REGI IIRFrI 1/VLITFR <br /> SETBACj_K AREA. This structure to be used as private residential <br /> 5. 1be-frD tn V0 `'f'©, ao r- D <br /> j�,�,g, garage/storage only. Not to be used for human CD W D M CL <br /> 0 <br /> 6. habitation. a a `D <br /> .o. o" N0 �' DC. <br /> C cn <br /> 7. o n -n <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy,of W 0 �" = <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD <br /> CD <br /> 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ? <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 b "con. <br /> Q <br /> m <br /> ,�-- ' CD <br />