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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 /> ^_ r <br /> C O <br /> OWNER u,r- TELEPHONE <br /> p m <br /> MAILINGADDRESS 70 �Y11s � O <br /> r <br /> (� o <br /> PROPERTY ADDRESS <br /> A <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> DWELLING/BUILDING ❑ CiARAGElACCESSORY STRUCTURE. ADDITION ❑ cn ° <br /> TYPE OF PERMIT(S): Q <br /> CL <br /> FILLING/GRADING ��❑ CAMPING UNIT [I SUBDIVISION ❑ < <br /> STRUCTURE/ADDITION USE: c/he Tne— <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) to <br /> BUILDING CONTRACTOR: C <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n0 O ^ <br /> A N V <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 5 m �u <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y 1 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO m (f o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I ( Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. \ C 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. vQ N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS C � ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 o YJ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT o <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 r _ <br /> PERMITTED. vlr <br /> 4. NO STRUCTURES, INCLUDING RETAININr;WAI I S FT(. Al I r1WFrl WITHIN THF RFhI IIGFr)IA/ATrP <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. Q k I� / garage/storage only. Not to be used for human <br /> 6 habitation. 0 = 3 Q 0 a A <br /> v o CD <br /> m C 0 0 S � 3 <br /> 0 i <br /> 7. o m � x <br /> I declare that this application (including an accompanyingscheaule has been examined b me and to the best of m <br /> PP ( 9 Y ) Y Y G`) - C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m' n <br /> all information contained in this application(including any accompanying schedule)and I 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- ° t7 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am d o <br /> P P Y Y ry Y� 9 �; <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized perso ave access t e above described premises at any reasonable time for the purpose of inspection. T `D o <br /> CD <br /> N n <br /> SIGN HER <br /> (sr ature of er or building contractor) (date) 0 <br /> MZONING ADMINISTRATOR �Q <br /> -+fA EA EA EA N <br /> TOWNSHIP PERMITS MAY BE REQUIRED Q <br /> THIS P RMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAN E <br /> Pfm k d- le4-4 ( IA'o ',iv wa 1-oy_U ryDS- <br />