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E <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> ^` <br /> W 0 <br /> OM vl Y✓ <br /> N <br /> OWNERLir; ( � 4r,= I l TELEPHONE 14o M P `7 f 5"a 4 y-a71$g <br /> , C !Y„ <br /> MAILING ADDRESS <br /> Home �;19e �ond � Oscea Q wi <br /> 1 $. S��is O <br /> PROPERTYADDRESS `— /V <br /> LEGAL DESCRIPTION(see tax receipt)S.9 THD /�. 7 l n//oq AlE (�/ <br /> / O <br /> Y V / 17 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ <br /> W m <br /> TYPE OF PERMIT(S): o' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: 3 '5 P R So h 1ar/ �(L) / a <br /> i ((J� y <br /> !!! <br /> (Home/Cabin, Commercial Business;Bedroom; Deck;etc.) <br /> rcf L d <br /> BUILDING CONTRACTOR: O UJ <br /> d <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3, t <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> cO <br /> a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. "SlI Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o A <br /> NORTH(N). C n <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 'P <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <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. <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 /> t <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 <br /> CONDITIONS OF PERMIT: O 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. N <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. <br /> 6 This structure to be used as private residential <br /> 6. � n �D 0 D O <br /> garage/storage only. Not to be used for human $ 3 a 0 x a z <br /> 7. habitation. _ m c y o ,= 3 <br /> Z in m =i <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my = p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible G) <br /> for the detail and accuracy of m 0 : v+ S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o m E o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m 0 <br /> sue a permit. I further accept all liability which may be a result of the¢¢p�ttt I ' is information I am 0: ' <br /> providing in this application. I agree to permit county officials char d <br /> authorized person to have access to the above described premises e r dinances or other m <br /> bee of Inspection. <br /> -n <br /> : O <br /> SIGN HERE r tGj d 3 `o° D <br /> (signature of oigner or building contractor) <br /> (date) <br /> ZONING ADMINISTRATOR69 <br /> ZONING N o g o <br /> TOWNSHIP PERMITS MAY BE REQUIRED —�7 <br />