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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N � <br /> /1J� N <br /> OWNER �d Sl LfSS-:Z3Q14 C <br /> \C PCf� 00 i TELEPHONE n <br /> HOME ADDRESS I"l jg- GNVe✓l- f}VC SDV1 1 U l!J 7S— OO <br /> EMERGENCY/FIRE NUMBER iL,q A 9 ROAD NAME (j kjl I Jq <br /> LEGAL DESCRIPTION(see tax receipt) j 8li Z 1"�UWv L{D ,v t 15' (a( C 7r) V P ]j m <br /> DWELLING/BUILDING ❑EEDWCESSORY STRUCTURE 9 ADDITION ❑ PRIVY ❑ 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o, <br /> STRUCTURE/ADDITION USE: <br /> GmxA�a iRS x :3L <br /> (home/Cabin;ommer lal Business; Bedroom; Deck;etc.) N <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M �d <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m t ��3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF �o <br /> v\ <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 /> BUILDINGS, ROADS,LAKE, LOT LINES. a <br /> 5. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. e 1 <br /> o � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q o <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <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 t <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA.�J�� <br /> 5. SDI * 61 Al -- S- 2-off - ( <br /> 6. CD <br /> This structure to be used as private residential � < °' _ o "' <br /> 7. garage/storage only. Not to be used for human a : " ; 3 <br /> habitation. o =M m <br /> I declare that tl,im dppncaoon tmciudmg any accompanying schedule) has been examined by me and to the best of my �j c p <br /> knowledge and belief it is true,correct and complete. I acknowled that I am responsible for the detail and accuracy of m E. c <br /> all information contained in this application(including any accoM ya schedule)and I further declare that I recognize CD m <br /> that this information I am providing will be relied upon by the of rnett Wisconsin in determining whether to is- p <br /> sue a permit. I further accept all liability which may be a oflfte, of Burnett relying on this information I am l m <br /> providing in this application. I agree to permit county�o aIs charm; ministering county ordinances or other m <br /> authorized person to have access to the ove describe emises at any bna time for the purpose of inspection. -n .'• <br /> C <br /> SIGN HERE w 4y� _ 3(,L6 <br /> ignat of wn -or building co J (d e) <br /> ZONING ADMINISTRATOR <br /> wF»tn t»ww <br /> ' N N (21NNfTN <br /> VI V1ONp1OO <br /> Z/wNSHIP PERMITS MAY& R�E�11 <br />