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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v Q z <br /> 1 <br /> p APPLICATION FOR LAND USE PERMITS 01 °- IIIk11�o�,, <br /> OWNER h�A) f AriA-il �1' TELEPHONE 6S�- 73 cica97 I� <br /> MAILINGADDRESS a11� \ �ICC77 <br /> PROPERTY ADDRESS _—,7 <br /> LEGAL DESCRIPTION(sea tax receipt) 1I <br /> to <br /> DWELLING/BUILDING J GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): I (�� o ,°� � <br /> Fit LIN=/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ la I�( /�� U <br /> STRUCTUREIMDITION USE: '(Home/C � n: Co�m <br /> u .; stir) cJ= D <br /> g- <br /> il <br /> Deck; w <br /> BUILDINGCONITRACTOR: <br /> N <br /> A PLOT PLAN MUST BE PROVIDED ON LEAST AN 8%X 71 SHEET OF PAPER. ANV INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3. <br /> O <br /> O <br /> _DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) F <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. To -T <br /> Z. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE In A <br /> NORTH(N). C �- O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO MO <br /> CENTERLINE OF ROAD,(C)SUILDING(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 GRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS,LAKE,LOT LINES. C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. S <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 /> u <br /> NOTE: NGISTRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED, <br /> c <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c p <br /> CONDITIONS OF PERMIT: T� j� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 66 DAYS OF PERMIT `V 4 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WAI I S ETC At I OwFD WITHIN THE RFOD IRFD WATER <br /> SETBACK AREA. <br /> 6_ This structure to be used as private residential <br /> 6 garage/storage only. Not to be used for human a m n a o a o <br /> habitation. g" x 3 a @ a A <br /> D »o= 3 <br /> T. <br /> I declare that this application(Including any accompanying scnedmel nes Dean examineg py me arm to me Deal or my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a F ' <br /> C <br /> all Information ahon Information <br /> I a In this application relied <br /> upon <br /> any accompanying schedule)and I further declare that I recognize n $ m <br /> that this information I am providing all liability <br /> will <br /> it be relied upon by the County of Burnett Burnet re in determining whether to Is.sue <br /> pro i permit. s appli accept all liability which may county <br /> o result of the County of Burnett relying on this information I other v o <br /> providing In this application. I agree to permit county officials charged with reasonable <br /> timeadministering county purpose <br /> fiordinances pe other 'm <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGNHERE m ' n <br /> (aignatura ofl �nbuiltling contractor) (date) <br /> o.1. o i <br /> ZONING ADMINISTRATOR JIYr I I0,n(OQn ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED g N o N H N o <br /> THIS PERMIT SHALL EXPIRE ONE YE I FROM DATE OF ISSUANCE <br /> W <br /> t le-hr/Yyf� 7� o AliY giant 6-36 a, <br />