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Burnett County 7410 Co.Rd.K,No.102,Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS �X <br /> ; 0 <br /> OWNER / TELEPHONE <br /> e <br /> MAILING ADDRESS /� / �-Y sbj;>. <br /> PROPERTY ADDRESS 1111CS ASd A O e- <br /> t C <br /> LEGAL DESCRIPTION(see tax receipt) 38 <br /> O m <br /> Ca boa <br /> DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE D4 ADDITION ❑ rn"� <br /> TYPE OF PERMIT(S): 111,,, <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ sueorvisioN <br /> STRUCTURErADDmON USE: D A"S Cf> J�? PnYcc <br /> C (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ff �S�"dY d <br /> BUILDING CONTRACTOR: O�I T 1 t SLA�l Iay-fyn ICJ � <br /> W 1 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LE AST AN SYa X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNE p <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (A RIAL OR TOP VIEW) -n g00 <br /> M ^QI:E <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DIST CES TO BE SHOWN OR DRAWN TO SCALE. m :b2. SHOW THE LOCATION AND SIZE OF AL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m � P <br /> CENTERLINE OF ROAD,(C)BUILDINGS MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF �d Z <br /> LAKE,STREAM OR RIVER AND MEASU EMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(VY),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE,LOT LINES. C>• <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED ORED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED II AN ARCHITECT, ENGINEER,BUILDER,CONT HE PLANS93 <br /> _ <br /> MUST BE SIGNED AND DATED BY THE:WNER. � �NOTE: BUILDING/STRUCTURE LOCATION MUST BE STAKED SO AN ONSITE VERIFICAT MAY BE D q S <br /> NEEDED. SEP <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: BVAi <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITI� 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES ANDEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERA IONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. d <br /> 4. NO STRUCTURES,INCLUDING RETAIN[ WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. This structure to be used as private residential zo a <br /> 6. ` garage/storage only, Not to be used for human $ a FL a <br /> habitation. a 00 <br /> a o <br /> �. <br /> o � s <br /> I declare that this application(including a accompanyingschedule)has been examined me and to the best of m cr' p <br /> PP ( 9 by Y O ff ? C <br /> knowledge and belief It Is true,correct and c omplete. I acknowledge that I am responsible for the detail and accuracy of <br /> all Information contained in this application Including arty accompanying schedule)and I further declare that I recognize o G <br /> that this Information 1 am providing will be r tiled upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability wh ch may be a result of the County of Burnett relying on this information I am m <br /> providing In this application. 1 agree to psi rnit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the abo a described premises at any reasonable time for the purpose of Inspection. o <br /> �j <br /> SIGN HERE�fE 4a&s4L�����_Y�j�c.�,] <br /> (I 7tgnatuawwof capaillilir org contractor) (date) "V i <br /> t ' E <br /> ZONING ADMINISTRATOR <br /> (�N4 NNOO <br /> NON V7OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />