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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 office Of Zoning Administrator "Dci Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> r <br /> N <br /> C <br /> TELEPHONE <br /> m <br /> MAILINGADDRESS �� y(� �� �rG�e C_ 1_ C1 c4r�Q�� \�O O <br /> r � m <br /> 0 <br /> PROPERTYADDRESS ��y� yCr csreeh 0.55 Z' ~ <br /> LEGAL DESCRIPTION(see tax receipt) t to <br /> -- _ P' Fz� <br /> TYPE OF PERMIT(S): GARAGE/ACCESSORY STRUCTURE ADDITION ElC j �. <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �: <br /> STRUCTURE/ADDITION USE: o <br /> / �b(ome/Cabin; Commercial Business; Bedroom; Deck; etc.) W <br /> BUILDING CONTRACTOR: 5-La ', snow ? n <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m 3 <br /> O — <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) M <br /> -n o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> n o � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <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 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. Q> <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. 2 o <br /> O Z <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. Z r4zz�l t <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. (` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY G <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAININr;WAI I c PT(-. Al I nWFh WITHIN THF RF:nI IIRFn 1NATFR <br /> 5 SETBACK AREA. This structure to be used as private residential <br /> garage/storage only. Not to be used for human A W O r D O D o lu <br /> 6. habitation. 3 a@ 0, a A <br /> 7. O N y N J 3 <br /> Z C rn ID O tO <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my � v A <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of a ^ : v <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m rrt <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Q® ° (n : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am fS d o <br /> providing in this application. I agree to permit county officials charged with administa ir m <br /> authorized person to have access to the above described premises at any reasonable e f m <br /> CL : <br /> Q <br /> D <br /> SIGN HERE .. _b _ nQ , <br /> gn lure of o 'ng contractor) <br /> APR <br /> Ida r1MC o <br /> APR t7 LWJ <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNTY 1�r\(\j1`� '`" <br /> rO N(T W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR �R�I, <br /> ODtgT�OF,ISSU ANC�el /w," `b <br />