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Burnett County 7410 Co.Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator TI 02 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> _ r <br /> N o <br /> w <br /> c Q, <br /> OWNER I TELEPHONE S y y y o p �, <br /> CD MAILING ADDRESSJqZ q^a� O <br /> PROPERTY ADDRESS ZQ 1 Si <br /> ° — <br /> LEGAL DESCRIPTION(see tax receipt) ( (�L / _f Et V ra� eS V? <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ <br /> TYPE OF PERMIT(S): cCr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> r i <br /> STRUCTURE/ADDITION USE: <br /> �A( nc S r(e � � n <br /> ( ome/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> W <br /> BUILDING CONTRACTOR: �� nsy 2.� <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> n n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C c7 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m <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 V <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 /> CD <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. o <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o 0 <br /> NEEDED. <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o d <br /> CONDITIONS OF PERMIT: Q� <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. ®' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. ®® J - <br /> 5 r-i vey— <br /> 6. .J 1.., This structure to be used as private residential > � � n F m <br /> a4 <br /> 1 5i 7 oar <br /> garage/storage only. Not to be used for human o ID n y S A <br /> 7. ( v m C w w o <br /> C y N o <br /> habitation. ? CID <br /> _ Cn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj 69 A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <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- in : 0 <br /> O : <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 0 o <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other `D <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> -n <br /> m > : <br /> CID <br /> SIGN HERE �( sj.Cl- <br /> (signature of owner or building contractor) (date) 0 <br /> ZONING ADMINISTRATOR <br /> ✓✓✓ ON (ll (J fJNO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Perm le I e v,, Lei ,to &2 0b,2sf LkCj'6,-�' S-g c�� <br />