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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N ) <br /> N <br /> C <br /> q N <br /> OWNER I o n h W V�//L1 TELEPHONE 0 <br /> MAILING ADDRESS a ' /L{�l�J �1/✓ l` Cmm/1 <br /> rCD <br /> 1 7 <br /> 0 <br /> PROPERTYADDRESS (�Qrn e <br /> LEGAL DESCRIPTION(see tax receipt) /� m S <br /> 2 <br /> DWELLING/BUILDING.❑ GARAGE/ACCESSORY STRUCTUREk ADDITION ❑ I (n 0 <br /> TYPE OF PERMIT(S): Cr <br /> C <br /> FILLING/GRADING ❑ CAMPIN UNIT1❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITIONUSE: �a��'. S eCJ� 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) U) <br /> BUILDING CONTRACTOR: <br /> 4�z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SY2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> C c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(Na)AND INDICATE m <br /> NORTH(N). y 3 <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 Z <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. 7' N M <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS I 0 W <br /> MUST BE SIGNED AND DATED BY THE OWNER. o o I <br /> �0 oNOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> Z (7 <br /> CONDITIONS OF PERMIT: O <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �A <br /> ISSUANCE. , <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS_ FTC_. 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 /> M <br /> C m 00 <br /> 6 0 8 habitation. 0 1 3 cL a <br /> OS ry C woi :0 <br /> Z c in m <br /> 7. oO N _T'< <br /> I declare that this application (including an accompanyingscnenuie nas Dean examinee o me ane to the nest of m _ r^ <br /> Pp C g Y ) Y Y E �� � ; C <br /> J <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of J <br /> w <br /> all information contained in this application(including any accompanying schedule)and I further her declare that I recognize n <br /> � � 0 <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- YJ cn `• <br /> sue a permit. I further accept all liability which may a result of the County of Burnett relying on this information I am m ' o <br /> providing in this application. I agree to permit cou officials charged with administering county ordinances or other <br /> authorized person t e access tot above esc i d premises at any reasonable time for the purpose of inspection. m o <br /> m <br /> SCD <br /> SIGN HERE L )VW <br /> " <br /> (signature of owW or building contractor) (date) `r A` 0 <br /> ZONING ADMINISTRATOR <br /> J �lli Efl fA fA�N <br /> CO D1 O CW�I (n (T O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />