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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator m c c <br /> APPLICATION FOR LAND USE PERMITS �. <br /> ^' r <br /> y O <br /> V <br /> � - <br /> 51'7 <br /> OWNER TELEPHONE a <br /> Uv ( <br /> w <br /> CDO <br /> MAILINGADDRESS 6 Y �� ( 10 <br /> 0 <br /> PROPERTYADDRESS A-m?�v tot <br /> -1 <br /> -12 <br /> LEGAL DESCRIPTION(see tax receipt) cn <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ (v/� Ch 0 <br /> TYPE OF PERMIT(S): '\ 1 cr <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ <br /> m' <br /> STRUCTURE/ADDITION USE: L7 k1 ork <br /> (Home/Cabin;Commercial Business;Be room; Deck; tc. U <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN7%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> T o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DIS ANOES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF LL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn n <br /> NORTH(N). y \ 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE OLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDIN (S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF i c <br /> LAKE,STREAM OR RIVER AND MEA REMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS, LAKE,LOT LINE 3. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTE 3 BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0. \ <br /> MUST BE SIGNED AND DATED BY TH OWNER. �� O <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN y <br /> 3. <br /> NEEDED. <br /> This structure to be used as private residential <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. garage/storage only. Not to be used for human o <br /> CONDITIONS OF PERMIT: habitation. <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. r� O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V' <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETA114ING WALLS, ETC., ALLOWED WITHINTHEREQUIRED WATER <br /> 5. gTBACK AREA 36 �-C pm A, - I U l I-vne- . ( C'j- G <br /> ou <br /> X50 <br /> � �0vCS: <br /> v � <br /> CLCD � = RM <br /> 4D Co <br /> V r"' I•� �I✓7 "`�l� WS / lJ� �`-'uyC[fJI ���Oi1. O y CODZI,G N J m <br /> m <br /> I declare tha thls a lic on (including n accompanying schedule has been examined by me and to the best of m <br /> knowledge and belief it is true,correct an J complete. 1 acknowledge that I am responsible for the detail and accuracy of v Fu, <br /> a ' <br /> m <br /> all information contained In this applicati n(including any accompanying schedule)and I further declare that I recognize m m o G <br /> that this information I am providing will b i relied upon by the County of Burnett Wisconsin in determining whether to is- J <br /> sue a permit. I further accept all liability 1 vhich may be a result of the County of Burnett relying on this information I am i b <br /> providing in this application. I agree to rmit county officials charged with administering county ordinances or other U3 <br /> CD m: <br /> authorized person o have access to the a ove described premises at any reasonable i r m o <br /> CD m . <br /> SIGN HER � <br /> is <br /> lure of Iw r tw ding contractor We) a <br /> ZONING AD INISTRATOR -LID <br /> I�2CIL'f SGQkrPorch 8'70 ab ( �inin(ni»c)'o <br /> cNi+ ocNNi� oo <br /> TOW 4SHIP PERMITS MAY BE REQUIRED BURNETT COUNTY <br /> THIS PERMIT SHA L EXPIRE ONE YEAR OF ISSUA�iNG <br /> Perm1+-, CnAr- rn1 <br />