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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m c o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 n _ <br /> y O w <br /> N <br /> C <br /> OWNER I �lrt�ta S l�ttYYti 1 ► l G l�t�l TELEPHONE �� Z_ l — g c(I 0 <br /> HOME ADDRESS 1 b q nns�bl,{ S r <br /> DA <br /> 0 <br /> EMERGENCY/FIRE NUMBERJ406 ROAD NAME <br /> °-1 1 � 8 - 'U -��- <br /> LEGAL DESCRIPTION see tax receipt) N <br /> DWELLING/BUILDING�1:1GARAGE/ACCESSORY STRUCTURE C ADDITION ❑ PRIVY ❑ c0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING El CAMPINGUNIT 1:1 SUBDIVISION ❑ <. <br /> 19 <br /> STRUCTURE/ADDITION USE: alt)c<i S�o(J• ° <br /> t <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> l <br /> BUILDING CONTRACTOR: PLS ` /^S <br /> v <br /> 1 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) d <br /> CD <br /> T o. <br /> •n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C f <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 [%t Z <br /> Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. _ <br /> 0 <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. 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. c 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o t <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. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLu....._..... . __ ,...r. r ,., rcR <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human X v d ro m <br /> s habitation. a a M y a ;a <br /> mcm 0 � 3 <br /> Z <br /> 7. o V)i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of Q n Lr <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m 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 <br /> to <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to hjoe acce above described premises at any reasonable time for the purpose of inspection. -n <br /> m <br /> SIGN HERE 24�- <br /> AIN s r�(' � 4M : <br /> (si ature of ow r build�iinfg-_coontractor) (date) <br /> ZONING ADMINISTRATOR • • • ' <br /> I wwd+401W64' <br /> N NUINMOul <br /> TOWNSHIP PERMITS MAY BE REQUIRED c) 0 0 0 c) 0 c) <br /> 1-7&891 <br />