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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> rp • <br /> �J <br /> UT o J <br /> OWNER TELEPHONE <br /> M►CHArxL T .t MIAIArw A . SntrTM r;�y- �It: <br /> HOME ADDRESS �. O. 13O)-e .227 6W M rl 13 Y Q C Wil f y l?y o O <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER x1oplj ROADNAME /fUNhAM G,gAep 1 <br /> R0. <br /> LEGAL DESCRIPTION(see tax receipt) S'F F A 77 IQ GN fr 0 ADO/T�/rorygL /NFO• SF/CC 7- 1 M <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE N ADDITION ❑ PRIVY ❑ rn ° <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �' <br /> / / N <br /> STRUCTURE/ADDITION USE: GIS R 1(4 F E 3�X <br /> (Home/Cabin; Commercial I�ss; Bedroom; Deck;etc.) cn <br /> � <br /> BUILDING CONTRACTOR: vUT.« �QCIPS <br /> v <br /> CD <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. "n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a fv�A� <br /> T 1 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y <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. <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 C�13 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° C9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° c1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. of <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT a <br /> ISSUANCE. Nv <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. v_ 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER rl�\J�II <br /> SETBACK AREA. <br /> 5. This structure to be used as private residential r D O n o v <br /> 6. garage/storage only. Not to be used for human g d LD. 3g g a :Em <br /> habitation. D y i ° ' A <br /> 7. ° y ;'� ` � m <br /> - � <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G> O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Tsue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to 11ve access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> CD <br /> SIGN HERE 211, <br /> (si a ofo r r building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOW SHIP PERMITS MAY BE REQUIRED <br />