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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 < <br /> r <br /> N O <br /> N <br /> (� ) �L n c <br /> OWNERWit@!/ B 7T V Lc e+ TELEPHONE 7/ ) '3.y n <br /> .2371 <br /> /� i, , 1, <br /> MAILING ADDRESS��.3.5 /'► �f'�Q� 6 "� o� <br /> m <br /> PROPERTYADDRESS O <br /> - vjc� � 3 <br /> LEGAL DESCRIPTION(see tax receipt) A�y r7B O <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE WI ADDITION ❑ y o' <br /> TYPE OF PERMIT(S): c = <br /> a <br /> FILLING/GRADING) El )CAMPING/UNIT J❑ SUBDIVISION <br /> . /❑ �. <br /> STRUCTURE/ADDITIONUSE: ?©Y-lahie sh,=a `/ 1C N m• <br /> 0 <br /> (Home/Cabin;Commercial Busin ss;Bedroom; Deck;etc.) (n <br /> BUILDING CONTRACTOR: <br /> Self 2. <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. n <br /> 0 H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> T a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(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)OFZ <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO P <br /> BUILDINGS, ROADS, LAKE, LOT LINES. :E <br /> S. 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: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a <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. 1/ ' <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. ri <br /> 5. L '�� This structure to be used as private residential <br /> X <br /> W d onov <br /> 6 garage/storage only. Not to be used for human 23 a m x a m <br /> habitation. a m e 00 w a- <br /> 0 == 3 <br /> 7. Z ino = � =1 <br /> o T� M <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my �y A <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m v+ C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 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- <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. fD <br /> -n O <br /> CD N <br /> SIGN HERE v1/1 / / /(� - G'4 `D n <br /> (signature Idif own r building contractor) (dater <br /> ZONING ADMINISTRATOR Ltd t <br /> w to <br /> fA fR d/fA� N <br /> N U t N N O O <br /> TO(TNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />