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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> VT O <br /> N <br /> � C <br /> OWNER k lA& 'l , , V/Gil� TELEPHONE 70,3,,5q/ <br /> MAILING ADDRESS <br /> l r m <br /> r o <br /> PROPERTY ADDRESS <br /> ��(�SkS �..�61��K.C- (�r �DW/1 G'f .StiLt'SS <br /> LEGAL DESCRIPTION(see tax receipt) G L &01( <br /> O 51 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ (q 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ \ a <br /> STRUCTURE/ADDI110NOSE: <br /> U X /� <br /> I y (Home//CJabbiin;Commercial Business; Bedroom;Deck;etc.) Cl) <br /> BUILDING CONTRACTOR: <br /> d <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> XI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n a <br /> "n — LZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. I <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED O N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONT PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o -- <br /> n 0 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT N MAY BE DON FN���44 <br /> NEEDED. I 0 ^ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. e V�N 3 X003 /'o v 1 <br /> CONDITIONS OF PERMIT: UR/VE� <br /> t DRIVEWAY <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 20/V/N0 UNT y <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,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential m d d > 0'a v -0 <br /> 6. 3 ac 0, * m <br /> garage/storage only. Not to be used for human a c y y o ! 3 <br /> 7. habitation. Z ; o -t <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n to <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 w <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 Inspection. r m <br /> l m o <br /> SIGN HERE <br /> a : <br /> (sig ownero building contractor) date) <br /> ZONING ADMINISTRATOR <br /> �\ <br /> EA fA di 63 <br /> N 0 0 0 N <br /> Ch 00 <br /> N O N U t O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />