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Burnett County 7410 Co.Rd. K,No. 102, Siren,WI 54872 Office of Zoning Administrator -0 ci z <br /> CD <br /> APPLICATION FOR LAND USE PERMITS . ` <br /> r OO <br /> ,{,�_ ///7 1 q Q m �] <br /> OWNER /✓fir 5 � 2 �( G. TELEPHONE �� �l — AS L —� L � 5 <br /> MAILINGADDRESS l O <br /> a o N � � oie. � �-�� � <br /> !LamcJ <br /> PROPERTY ADDRESS L �� O~ <br /> LEGAL DESCRIPTION(see tax receipt) T J , � \ / dU y2Ser , �12 \ <br /> 6 (D <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ a U) o <br /> TYPE OF PERMIT(S): rr,,,' C <br /> FILLING/GRADING El CAMPING UNIT <br /> /❑ SUBDIVISION ElW a <br /> STRUCTURE/ADDITION USE: T. <br /> C>C i /� ' l? 'Z c5 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) W <br /> BUILDING CONTRACTOR: r-- <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> " n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. :E! O zm <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C <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. o <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. <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 /> vcj <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN !:qz::Z�„ I <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o W <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <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 I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER C-7J <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential X 0 r a v a 0 v <br /> 6. garage/storage only. Not to be used for human m 3 a F a n <br /> habitation. -o m c <br /> 7. z N iD o <br /> M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m —T <br /> PP ( 9 Y ) Y Y <br /> �c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 2 : v> <br /> PP (including Yaccompanying ) 9 ar ` u <br /> all information contained in this application Includin an schedule and I further declare that I reco nize m m o om <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 <br /> authorized person to have acces to the ove desc ' ed pr ises at any reasonable time for the purpose of inspection. m c <br /> OF <br /> m CDo <br /> SIGN HERE i a 2 CJ3 Fn <br /> (signature of er or building eo rector) (d te) n <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> d <br /> Cn0L" CAoo <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE �� o�j --a3 <br />