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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator - o z <br /> APPLICATION FOR LAND USE PERMITS . <br /> y O ��\\ <br /> W <br /> OWNER ;� c TELEPHONE7� J <br /> 07L _ / m OJ <br /> MAILING ADDRESS �D� ��l 4(1 F L!/r s 340, f <br /> r � <br /> o <br /> PROPERTY ADDRESS <br /> d06 -j5«0- o3 -41,p <br /> �� <br /> LEGAL DESCRIPTION(see tax receipt) 0D b -'Iu16 -a 1 U) <br /> Q � <br /> DWELLING/BUILDING ® GARAGEIACCESSORY STRUCTURE 91 ADDITION ❑ � a, 0 <br /> a <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> y <br /> STRUCTURE/ADDITIONOSE: LL 0 <br /> (Home/Cabin; om rcial Business; Bedroom; Deck; e' .) rn <br /> BUILDING CONTRACTOR: <br /> _ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> My ^ w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) On � <br /> r <br /> ?t v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <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 c <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 6Q <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. m' F <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN °. <br /> NEEDED. `� C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Q ' <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 /> SETBACK AREA. ` <br /> 5' - — l U -U-3 This structure to be used as private residential M 0 r D o D O v <br /> 6 garage/storage only. Not to be used for humanm 3 a m 9 n m <br /> 'o N N <br /> habitation. z y �c <br /> 7. 0 T'< i m <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of m -rn: - : 0 <br /> PP ( 9 Y ) Y Y 6r- : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of @ n ; v, <br /> CL <br /> cn ' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 0 i m0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- pC ; � <br /> CD <br /> sue a permit. I further accept all liability which may be a result of the Count)to tion I am <br /> providing in this application. I agree to permit county officials charged wl t d of other o E : E <br /> m E cn <br /> authorized person to have ecce s to the above described premises at any r p o s ction. c : <br /> (D m : <br /> SIGN HERE <br /> (signature or building con or) OctZ <br /> o n <br /> late) CL <br /> M/141'"41-1 <br /> ZONING ADMINISTRATOR AItil�M -0Unl'4E I..I COUN I Y :' ; '• '• <br /> � di fA fA <br /> NroN0O0 <br /> Nv, <br /> ti; lea � )p - aA3 TOWNSHIP PERMITS MAY BE REQUIRED ZONING to 0 U1 0 0 <br /> I/11(0113 THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />