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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATI N FOR LAND USE PERMITS 3 ° ° <br /> r <br /> y O <br /> OWNER TELEPHONE �"� /J _/ �a J a <br /> m <br /> MAILING ADDRESS n O <br /> F <br /> �r m <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) I � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ (j'1 c -'� <br /> TYPE OF PERMIT(S): l <br /> FILLING/GRADING ElCAMPING UNIT ❑ SUBDIVISION ❑ Cr <br /> STRUCTURE/ADDITION QSE: 6 n I u -1"�Ofi (.- b Un 0 �z <br /> (Home/ In; Commercia Business; Bedroom; Deck; etc.) rn -� <br /> BUILDING CONTRACTOR: G <br /> ' <br /> 3 � <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. m0 C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 H <br /> O ot <br /> . <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o A <br /> m w <br /> NORTH(N). C n <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. �a <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO r <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED, t N O <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. '- ` <br /> 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN �� o <br /> NEEDED. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P y� O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT T' <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O vO1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ry <br /> PERMITTED. v <br /> 4. NO STRUCTURES, INCLUDING RETAINIAIn%AIA1 I c ❑Tr Al 1 r)WFn WITHIN TNF RFOIIIRFI)WATER V7) <br /> 5. SETBACK AREA. This structure to be used as private residential <br /> garage/storage only. Not to be used for human <br /> C0d0oQov <br /> s. habitation. :Em <br /> CD ,'cam am xaC5 A <br /> omCy ^ o � 3 <br /> 7. Z y H N O <br /> m ?tom i <br /> I declare that this application (including any accompanying schedule) <br /> M <br /> has been examined by me anb to the nest of my - E va: A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of y e <br /> all information contained in this application(including any accompanying schedule)and 1 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 <br /> sue a permit. I further accept all It '' h may be a result of the ounty of Burnett relying on this Information I am m o <br /> providing in this application. I ree to pe it co y official ged with administering county ordinances or other <br /> authorized person to have a ss I It ove de ribed pr ses at any reasonable time for the purpose of inspection. m <br /> -n d <br /> SIGN HERE �j m > : <br /> 5 va a <br /> (signa of owner or b ding c tractor) (date) ki : o <br /> ZONING ADMINISTRATOR <br /> 0-)T ' /7 <br /> Off: i i iii» <br /> M 69 EA fA N <br /> � OUOCWI, (W], CNTO <br /> TOWNSHIP PERMITS MAYBE REQUIRED <br /> THIS PERMITgLLE PIRE ONE YEAR FROM DATE OF SU NCE�mk� U <br /> or" <br />