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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> OWNER mlC��� — TELEPHONE n <br /> o <br /> m <br /> MAILINGADDRESS - rw � IC QVC woodbu V :� � 'a4j £O <br /> PROPERTYADDRESS algS� SDI rIT LJaLe 4 ) <br /> � - <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ 6 h <br /> TYPE OF PERMIT(S): Q i <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: 66L� ��� N <br /> ome/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: 1 bh <br /> m <br /> Z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. i." <br /> A y J � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m ,Z� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 0 <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 nn II <br /> BUILDINGS, ROADS, LAKE, LOT LINES. W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N (� <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. 0 <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g <br /> NEEDED. �t v,^ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z v l <br /> CONDITIONS OF PERMIT: P ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 r <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WAI IR FTC_ ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. Q This structure to be Used as private residential <br /> a. I�GI(76tr1C� /� garage/storage only. Not to be used for human p to o r- D o D o v <br /> 6. habitation. 0 `= 3 a o 0 a F,z <br /> F - <br /> 0 o m C y : O = 3 <br /> 7. Z C N O <br /> m <br /> I declare that this application (including an accompanyingscneawe nas oeen esameneu o me ane to uesi ur m ' ^ ° d+ A <br /> PP ( 9 Y 1 Y Y i �'c ? N : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is. ' m in <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ,o <br /> authorized person to have access to thA above described premises at any reasonable time for the purpose of Inspection. ` m <br /> r n : <br /> SIGN HERE <br /> (s tura owner or building contractor) (date) W 0 <br /> ZONING ADMINISTRATOR Um �IA.rllaRh �' <br /> V O [T O U (T (ll O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM D TE OF ISSUANCE _ 6-61—b6 <br /> 11 11--r <br />