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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y O <br /> LL. � _OWNEFd ^p <br /> / I ` � L v <br /> MAILINGADDRESS �U IJC� 3 S �Q.�bt, Y't, U 4 SG J c(O 3Q _ <br /> PROPERTY ADDRESS <br /> Q <br /> LEGAL DESCRIPTION(see tax receipt) <br /> TYPE OF PERMIT(S): <br /> DWELLINGIBUILDING ElGARAGE/ACCESSORY STRUCTURE ADDITION ❑ <br /> is�0 4 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> STRUCTURE/ADDITION USE: <� 2q�6' <br /> -r _ 14&.O 1C5if0e Q, <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> m <br /> BUILDING CONTRACTOR: <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 /> A N l^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Fj m 'r A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE to a <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)OF I Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO i <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. -fr� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> `o f I <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. z <br /> CONDITIONS OF PERMIT: P <br /> 1 <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 WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> A W O r DO D 0 � <br /> 6. habitation. F 3 n m x a a <br /> 7. z N y c oU <br /> O m TK : A <br /> I declare that this application (including any a.t. ,,,Ya„r,,,y 1.43* &X«, y ,,,r anu to the best of my ^I A <br /> ueu u <br /> owm M 0 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 'm 0_ <br /> all information contained in this application (including any accompanying schedule) and 1 further declare that I recognize m c ' mo <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `D <n <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett rel in on this information I am 1 m o <br /> providing in this application. I agree to permit county officials charged with admi ' i €rt [ <br /> authorized person to have access to the above described premises at any reasons t e ti <br /> T <br /> �' � d <br /> CC N <br /> SIGN HE � ` <br /> z7- (sighatureofowne or bu _ contractor) DEC (dat Al i ii o <br /> �7 n// CC1utN7JJ ' o E <br /> ZONING ADMINISTRATOR \l rrf J lLt.n iV'r.(n i <br /> BURNETT COUNTY <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATEF I SUAN E d J /—G <br /> bc, <br />