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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -U ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> c. 0 n "\ <br /> OWNER (2 Y� / / Z�C �/¢�< /J/oeeI t s /I V(-TELEPHONE Z c <br /> 1 � ' < %ci <br /> o \ <br /> ���`c� Ay s/ P i h el Rush Cfy /9/l/ ES66 o <br /> MAILING ADDRESS � <br /> o � <br /> PROPERTYADDRESS 3S'� 1 P �� U <br /> LEGAL DESCRIPTION(see tax receipt) aL 1 Ll Cs m V/ -oa 93 3�-Sly,- /Sl� 0 <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ® ADDITION El <br /> Q <br /> a <br /> y o <br /> TYPE OF PERMIT(S): ,7 (/ Q <br /> FILLING/GRADING ❑] �CAM�PING UNIT ❑ SUBDIVISION ❑ "'-' <br /> STRUCTURE/ADDITION USE: ��� o? x Y Qj/f- o <br /> (Home/ abin;Commercial Business;Bedroom; Deck;etc.) (n <br /> � e � � <br /> BUILDING CONTRACTOR: � ( <br /> 12 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. .n 3 <br /> A c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C p , n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m N <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. 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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. i <br /> o f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN O <br /> NEEDED. ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. x1 \ h <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3 NOGR TDEDG OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6)4 X -SrThis structure to be used as private residential ;a 0 r a v D o v <br /> 6. garage/storage only. Not to be used for human CID 3 a m M a m <br /> habitation. -5- m c y o g 3 <br /> 7. Z w m o o <br /> P _TZ <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my r^' i A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am res ,, 11 O S <br /> P g responsible for the detail and accuracy of W n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m C <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 this application. I agree to permit county officials charged with administering county ordinances or other d <br /> authorized person to have acciss o the above described premises at any reasonable time for the purpose of inspection. D cn <br /> ; o<(D N <br /> SIGN HERE <br /> a : <br /> (signature of owner or ng contractor) (date) <br /> ZONING ADMINISTRATOR <br /> ,(`• EA EA fA fA� N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> V cn ocn �noo <br />