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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> U T <br /> N � <br /> /�.,fit ` I �/ o /� <br /> OWNER NEIL_ i G`Ap-b tV&FZ_ TELEPHONE(l�p?j �C��`(PG?q 0 � �v <br /> m W <br /> HOME ADDRESS A-0 <6-F �l"aL i4m, 5s;f24 <br /> r � <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) PA-V-T- o(: �3Z-�3zS-a]� � � ' ' "�"��'1 ' e <br /> C � <br /> e <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY rn <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> N <br /> STRUCTURE/ADDITION USE: S'1-t� v G <br /> ome/Cabi ial Business; Bedroom; eck;etc.) <br /> �p1 <br /> BUILDING CONTRACTOR: Eu <br /> v <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. <br /> A m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> -n o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 4J <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. <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. 9jTHIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. W <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. O <br /> 5. 11 <br /> M 'U <br /> . A '0 Or O � o <br /> This structure to be used as private residentialwr-�� C11 = d d 00 1 m <br /> CL <br /> 6. garage/storage only. Not to be used for human <br /> ` � c' No 3Q <br /> habitation. Z y 0 ' <br /> 7. '0 -I <br /> o Q <br /> (y <br /> 2r: m J <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)n10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of c 9 c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m O <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 <br /> providing in is application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized pe n to have access to the above described premises at any reasonable time for the purpose of inspection. -n S <br /> CD <br /> m <br /> SIGN HERE <br /> Cly�o� l 6 <br /> (signatur owner or building co cto (date) <br /> ZONING ADMINISTRATOR <br /> : moo <br /> TO NSHIP PERMITS MAY BE REQUIRED rc,� �.�o-v) �0 0 0� o <br />