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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATIO14 FOR LAND USE PERMITS <br /> 5 o <br /> Horne &S CD � <br /> OWN TELEPHONE e-F-1B <br /> MAILING ADDRESS t �, 'd F <br /> r m <br /> 0 <br /> PROPERTY ADDRESS 6 I <br /> p»`of loo-d of e.Sm Vol umf- 4,PAS <br /> LEGAL DESCRIPTION(see tax receipt) (AVE -1F �r 7-. I 2 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREX ADDITION ❑ �{ ( 0 <br /> TYPE OF PERMIT(S): V a <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ <br /> 3U <br /> STRUCTURE/ADDITION USE: ° <br /> ( ome bin;Commercial Business;Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: mn <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR B <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O <br /> 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AE RIAL OR TOP VIEW) O a()1 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL XISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n1 r� <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) VIEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASURE MENT TO WETLAND AREAS. P <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. Q` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED B AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. £ ` <br /> O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN •`^» 0, <br /> NEEDED. 1i7j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ll" <br /> CONDITIONS OF PERMIT: o <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. O <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER E <br /> s. � <br /> SET AC� <br /> � This structure to be used as private residential � <br /> garage/storage only. Not to be used for human d iv( o a o v <br /> 6. � f m <br /> f2� <br /> habitation.ation. 3 n g F a 70 <br /> a CD C: <br /> 7. Z N o <br /> o ":2 <br /> in <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of mytt 11 �F �! C <br /> knowledge and belief it is true,correct and co plete. I acknowledge that I am responsible for the detail and accuracy of W; c a , A <br /> all information contained in this application(h icluding any accompanying schedule)and I further declare that I recognize (D o my <br /> that this information I am providing will be rel ed upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability whicri may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to perrr it county officials charged with administering county ordinances or other o <br /> authorized person to have access to the abovi described premises at any reasonable time for the purpose of inspection. fD W <br /> -n o : <br /> 1! (D m <br /> SIGN HERE R zo-©X <br /> a <br /> (signature of ownel or buildin tractyo-r)) (date) / <br /> ZONING ADMINISTRATOR �r t <br /> EA fA FA FA � N <br /> N (T N N O O <br /> UO (T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />