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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 /> OWNER TELEPHONE �l S - F(�6- <br /> MAILING ADDRESS Z114 9's Z1.)," <br /> m <br /> PROPERTY ADDRESS <br /> �J <br /> LEGAL DESCRIPTION(see tax receipt) � <br /> (�7 ,,`t <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE l6J ADDITION ❑ l� U) 0 o <br /> FILLING/GRAD G ❑ CAMPING IT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: x vU o C' <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) y <br /> m <br /> BUILDING CONTRACTOR: eH '/nS '- <br /> iu <br /> m <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. .n <br /> O H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O O <br /> n a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m o A <br /> NORTH(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 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 <br /> i BUILDINGS, ROADS, LAKE, LOT LINES. <br /> I <br /> S. 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 Oo <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 c <br /> v <br /> CM <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 5t o <br /> NEEDED. <br /> This structure to be used as private residential <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELO% garage/storage only. Not to be used for human o <br /> CONDITIONS OF PERMIT: Q <br /> habitation. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. pW <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 6. / v 'L ;a <br /> 7. Z y C 0 <br /> �� 3 <br /> p M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 : d, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �, <br /> ' m' O <br /> sue a permit. I further accept all liability which may be a result of th ng on this information I am <br /> providing in this application. I agree to permit county officials ch Aounty ordinances or other t <br /> authorized person to h e access to the above described premises All, the purpose of inspection. �" W <br /> m o : <br /> m m <br /> SIGN HERE 6f t r 2 o 2003 C1 <br /> a : <br /> (signature of ow r building con or)� (date) <br /> ZONING ADMINISTRATOR <br /> ZONING N 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />