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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v O Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> 5T 0 <br /> P +L c -,n <br /> OWNER ALAAI 1 ALMA S t IJ TELEPHONE <br /> W �1 <br /> MAILINGADDRESS 5/ /7 ���p0 I l U �_ � `}� O <br /> 1 � <br /> PROPERTY ADDRESSU / / /ro-ak <br /> 1, <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION El TYPE OF PERMIT(S): O U) � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: G a oz. 4(Z'C o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) C <br /> BUILDING CONTRACTOR: 3 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �t - <br /> C y <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) <br /> T a J ^ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n <br /> M m <br /> NORTH(N). 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 I <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Q J Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO J o <br /> BUILDINGS, ROADS, LAKE,LOT LINES. O <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 ° 0 i <br /> MUST BE SIGNED AND DATED BY THE OWNER. '- V <br /> o <br /> � I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 7 <br /> ° <br /> NEEDED. . ( <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( ., <br /> ISSUANCE. W I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. Uj <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> s. habitation. �] co C7 r > 0 > 0 -0 <br /> M C N A „ a E m <br /> mZ x3aN 10XDy7. O N <br /> j <br /> Oy 0 <br /> O <br /> o m m <br /> I declare that this application j the best of my E q v,[ A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of i o J <br /> cn <br /> all information contained in this application (including any accompanying schedule)and I further declare that 1 recognizem $ m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ' (b0 <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 o <br /> providing in this applic io I agree to permit county officials charged with administering county ordinances or other m' <br /> authorized p o to hav acc s to the ove described premises at any reasonable time for the purpose of inspection. m <br /> -ncL <br /> SIGN HERE (DD ; <br /> l� �� O to n : <br /> (signature of o ner or building contractor) (date (� o <br /> W i t : 0 <br /> ZONING ADMINISTRATOR Jim / rte, (j <br /> © '69 1.9 <br /> in 9ifl en'-r' <br /> GocNnocnc <br /> TOWNSHIP PERMITS MAYBE REQUIRED W rQ0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />