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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> N <br /> OWNER 14Ljk7/ �l J,�/�((�„� TELEPHONE 61Z — <br /> HOME ADDRESS <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) OAS —.4106 D1 - /I V <br /> 0 <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ CDo ' <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: STO A bC 412466= H <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) y <br /> _ a <br /> BUILDING CONTRACTOR: 7A)L <br /> •o <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> In ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> �I in \1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o Q <br /> n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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. IV <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 9 { <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: 1 <br /> C> <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED V 1 E REQUIRED WATER <br /> SETBACK AREA. <br /> 6' � CP (D;avnr v�vrn <br /> This structure to be used as private residential rn <br /> a o a e <br /> 6. mcm oT <br /> garage/storage only. Not to be used for human Y l�a] z " R <br /> :F, <br /> 7. habitation. ; <br /> : H ;a <br /> P1 FP- =m: m <br /> I declare that this application (including any accompanying schedule) d by mea o'the best of my <br /> '•nowledge and belief it is true, correct and complete. I acknowledge that I am fisie and accuracy of �;. ' a <br /> information contained in this application(including any accompanying ache n irthef declare that I recognize �j o m m <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- v <br /> Voermit. I further accept all liability which may be a result of the County of Burnett relying on this information I a m <br /> a g in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> I person to have access to the above described premises at ny reasonable time for the purpose of inspection. m ; <br /> CD : <br /> SXG\ m <br /> ZON\N (sl ature of owner or buildin o actor (dot ) <br /> '1ATOR <br /> N K) Ln N01 <br /> P PO V1P <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 <br />