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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> n O <br /> n <br /> C <br /> N <br /> OWNER QA/DA4ls1 -;f+`1 • el TELEPIONE �' ¢ d <br /> MAILINGADDRESS 0 y 9 Q �[G1 E7G?T� I�(� o <br /> PROPERTYADDRESS S'01 <br /> � G <br /> LEGAL DESCRIPTION(see tax receipt) <br /> .00V�^�� <br /> DWELLING/BUILDING ISN GARAGE/ACCESSORY STRUCTURE ADDITION ❑ © � 0 ` p <br /> TYPE OF PERMIT(S): !!! Cr 'T <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> In <br /> STRUCTURE/ADDITION USE: L° o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc. <br /> BUILDING CONTRACTOR: p <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> M <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. v A <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 <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 <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 /> o � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: RJ <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, INCLUDING RETAINING WAI I G FTr. Al I r)WFn WITI-I M TNG Di=nI IIDCrl%AinT1=0 <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. <br /> garage/storage only. Not to be used for human C m W 0 D v D o M <br /> N � d0 0afm <br /> 6. habitation. o 3 <br /> ' <br /> LD. <br /> o� cN `� o � 3 <br /> Z ccy m O <br /> 7. o -n M <br /> m <br /> I declare that this application (incivaing any accompanying schedule) has been examined by me and to the best of myJO <br /> Q -4 ' C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c m <br /> that this information I am providing will be relied upon by the County of Burnett W' n in determining whether to is- s l7 <br /> sue a permit. I further accept all liability which may be a result of the County of i f m ( ? ' o <br /> providing in this application. I agree to permit county officials charged with ad ii �pbd c r <br /> authorized person to have access to the above described premises at any reaso im s f i -n a <br /> m n <br /> O v+ a i <br /> SIGN HERE <br /> (s' reofowns buil(di�ng contractor) t <br /> Aw <br /> ZONING ADMINISTRATOR I, ' J I �q tl yn BURNETT rgl viAiT..T ' <br /> rr7 — yi t ZONING o � �o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF IS U NC <br />