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Burnett County 7410 Co.Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator vM Z <br /> APPLICATION FOR LAND USE PERMITS <br /> C <br /> 0 <br /> OWNERCL <br /> o tkul,C i`A !.L/Le-/[L" TELEPHONE (�..1�- .3 7- Y-5 7�' O a <br /> MAILING ADDRESS 7 7�� � 5: JSU 0 O <br /> PROPERTY ADDRESS /,E el) ed 4& JCL,�n &,e-, y/~ <br /> LEGAL DESCRIPTION(see tax receipt) ,5 s w =-;)-6 -`lU-40 �S 1/j� Q <br /> I' V <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE_ Ik ADDITION ❑ CD <br /> i`Y► Cn 0 <br /> TYPE OF PERMIT(S): v ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> nn..// <br /> STRUCTURE/ADDITION USE:,oe/e <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m r <br /> BUILDING CONTRACTOR: �� ID.�� Clio !ldPlS d <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO <br /> 31 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> T �• Z ( ` <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n d jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). N <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO RI D <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. G� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c j <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 /> r7� � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <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 ) <br /> PERMITTED. <br /> 4. NO STRUCTURES�[J��UDINC {ETA G WA ETD WITHIN THE REQUIRED WATER <br /> SETBACK AREA.UU <br /> 5. <br /> mC vmrDima0m <br /> 6. This structure to be used as private residential 0 3 a g `s a W <br /> LD.garage/storage only. Not to be used for human 'a N o " ; <br /> 7. habitation. m <br /> declare that this application (including an accompanyingschedule has been examined b me and to the best of m — ^�' D <br /> PP ( 9 Y ) Y Y ` C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm 0 : EA : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o M <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 1 : <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 ` 0 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspectionm <br /> m o <br /> m m <br /> SIGN HERE 17, <br /> (signature of ner or building contractor) (d te) ` 0. <br /> 1 ` <br /> ZONING ADMINISTRATOR / E <br /> 9-1 : : : fAyr <br /> rA fA e) 0 N <br /> N (A NN <br /> N 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED cn o m u o 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />