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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 /> N O <br /> N � ` <br /> OWNER $KLlC R Ke wia, TELEPHONE <br /> m O <br /> MAILINGADDRESS ��(� rut1s�a� /�GQ �GL►i.bGMry +�1 + b /�jd <br /> r � <br /> �+ 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) 4 i,* OC-9 9 4 m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 1`° <br /> TYPE OF PERMIT(S): <br /> Q <br /> FILLING/GRADI G ❑ CAMPING UNIT 1:1 SUBDIVISION ❑ ( , 1 <br /> r p <br /> STRUCTURFJADDITIONQSE: V 1 F *P A 30 �() <br /> (Honme/C in;Commercial Business;Bedroom;Deck;etc.) d <br /> BUILDING CONTRACTOR: TEl'L(.LLXd <br /> v <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> M m <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. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <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 (3� Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO - p <br /> BUILDINGS, ROADS, LAKE, LOT LINES. Q) <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N rc <br /> S. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> o v� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o un <br /> CONDITIONS OF PERMIT: 6 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <br /> ISSUANCE. -1S) <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 <br /> X m <br /> rDi ODaa V <br /> r <br /> 6. garage/storage only. Not to be used for human g 3 a m 'x a <br /> habitation. z ° m o _ 3 <br /> 7. o T m <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my �j C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o my <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 w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. c <br /> m <br /> SIGN HERE <br /> (signature ner or building contra c (date) <br /> ZONING ADMINISTRATOR vi En <br /> C,,7di bA EA fA - N <br /> TOWNSHIP PERMITS MAY BE REQUIRED ��// <br />