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/ -I <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 <br /> Office of APPLICATION FOR LAND USE PERMITS Zoning Administrator G) Z <br /> o 0 <br /> r N <br /> N � <br /> OWNER M% 0AC L TELEPHONE n <br /> 1035- 'LQ'S`I <br /> MAILING ADDRESS <br /> 13�Li <br /> { <br /> PROPERTYADDRESS <br /> 0 <br /> LEGAL DESCRIPTION(see tax receipt) PC, <br /> �o- ly <br /> DWELLING/BUILDING ❑ <br /> TYPE OF PERMIT(S): GARAGE/ACCESSORY STRUCTURE LJ o <br /> ADDITION ❑ <br /> FILLING/GRADING ❑ ll, <br /> CAMPING UNIT ❑ SUBDIVISION <br /> STRUCTURE/ADDITION USE: / q <br /> (Home/(;abin; Commerci usiness;Bedroom; Dec ;etc.) o <br /> BUILDING CONTRACTOR: c (� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. v <br /> CD <br /> T 3. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> it y <br /> C 1^ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O c O\ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE Z <br /> NORTH(N). m m <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. <br /> 4. SBUILDINGS,ROADS, LAKE, LOT LINES. <br /> HOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAWFIELD(DF),AND ALL DISTANCES TO Z <br /> S. INDICATE F A WALKOUT BASEMENTS PLANNED AND SHOW AREAS TO BE GRADED OR F 1 0 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONT V` <br /> MUST BE SIGNED AND DATED BY THE OWNER. C•, LANS 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT i <br /> o <br /> NEEDED. MAY ONE 0 <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. p <br /> CONDITIONS OF PERMIT: e`/ANF� `� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ZCN�NG tj I� <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. This structure to be used as private residential `J <br /> 6 garage/storage only. Not to be used for human <br /> habitation. r D v a o <br /> 7. = 0mo m <br /> aoxTmA <br /> v mcwWw > >' _3 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Z y z o . 0 1 <br /> ° ?tom : m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of \01 <br /> 01 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (nE c ; <br /> 1J <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m i l7 <br /> 0 : A <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 o m <br /> providing in this application. 1 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. <br /> co i <br /> SIGN HERE m R <br /> m o : <br /> CD m <br /> isnat400f eror buildl <br /> tractor) <br /> ZONING ADMINISTRATOR (date) <br /> TOWNSHIP PERMITS MAY BE REQUIRED V 3S� D ���I 5 f�N N N O O <br /> �Ilnocno 00 <br />