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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -D G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> t F' 0 <br /> OWNER f C k ' 66 Mins TELEPHONE n <br /> 7/S <br /> MAILING ADDRESS 6&V9 Z,//q 44e o <br /> / L/rl /_ <br /> PROPERTY ADDRESS !ct?l�g 4 �90f n„' r�/p2,i <br /> c�r� ci70c7U I �T <br /> LEGAL DESCRIPTION(see tax receipt) <br /> `y ' 361 � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION is ? q, <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ Q <br /> 1 a r^ <br /> STRUCTURE/ADDITION USE: _ cJ'/�Q�Je/� (s' <br /> o' <br /> (Home/C , Commercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: <br /> --Ake <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11SHEET OF PAPER. ANY INCOMPLETE OR v <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 C <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) M <br /> 0 CD <br /> a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n O QJ Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 in m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF a <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. r Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO P <br /> BUILDINGS,ROADS, LAKE, LOT LINES. D <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. (p� 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: Zo t <br /> l a. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C <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 L1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. C,w-ay-ter ve /v to <br /> 6. This structure to be used as private residential m m d;� v a v v <br /> garage/storage only. Not to be used for human L ; a ; 0, a <br /> 7. habitation. Z g y 'W o 5 20 3 <br /> I declare that this application (includin P st of my m '--' 2 m <br /> °) in <br /> knowledge and belief it is true, correct � :;rp <br /> .uracy of � <br /> all information contained in this application(maudmg any accompanying schedule)and I further declare that I recognize m = v m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- j m <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 G o . <br /> cn : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reaso (D m <br /> -n a <br /> SIGN HERE CD m D <br /> gnat re of owner i g contractor) <br /> �' :` n <br /> (� is) o <br /> ZONING ADMINISTRATOR ': <br /> In i � in to <br /> a �N(Cn W W N O <br /> TOWN4SHIP PERMITS MAY BE REQUIRED BURNETT COUN/TY� o m o cn cn cn 0 <br />— THIS PERMITj �m l-I�E�'��–�, EAR l M DAI E OPIC�'���Grl <br />