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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 PE MITS 3. <br /> I r (� <br /> N 0 <br /> p <br /> OWER TELEPHONE (v�R 'UeY ®• ' � (IG / � <br /> .2-, <br /> m <br /> MAILINGADDRESS ��� Cleat� <br /> r m <br /> 0 <br /> PROPERTYADDRESS S(LYY� <br /> 3?8/5,?f 14311;210 S i TQCOI R/1_50i <br /> LEGAL DESCRIPTION(see tax receipt) 7—Z10-1r �I(9 ��9d0 Gl��GY Skcf S �df�g �m <br /> i nn 2 <br /> DWELLING/BUILDING 11GARAGE/ACCESSORY STRUCTURE Ill ADDITION ❑ N <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ / S.S. <br /> N <br /> STRUCTURE/ADDITION USE: 1^'70 <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) rn <br /> pp m <br /> BUILDING CONTRACTOR: J�' <br /> v <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. T — <br /> M <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. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m r�1 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF l3\% 1 _ <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES I 1 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. <br /> v = � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z g <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. i J} <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^v' <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. <br /> 5. <br /> This structure to be used as private residential A r a v a v v <br /> 6. garage/storage only. Not to be used for human 3 ' g � am m <br /> a m F _ .M <br /> o mCywoT3 <br /> 7. habitation. Z a ; o : _� =1 <br /> o -n ' [ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j c ID <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m n ; w <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o 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- <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized persortto have access to thp above described premises at any reasonable time for the purpose of inspection. m W <br /> m o : <br /> (D <br /> SIGN HERE i�l �� <br /> (s natur own or building contractor) (date) <br /> a <br /> g <br /> 1 <br /> ZONING ADMINISTRATOR v I <br /> ao�9� - ��N)r)0N <br /> (� N N N N O O <br /> `y] (T 0 (T 000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED e'V U <br />