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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 o° 0 <br /> APPLICATION FOR LAND USE PERMITS 3. = <br /> r <br /> N � <br /> N <br /> OWNER /1 NFG�-St�—1�• TELEPHONE � 5-- / // o <br /> O <br /> MAILING ADDRESS/ JF <br /> C`L% 'Jj <br /> r � <br /> [ 0 <br /> PROPERTY ADDRESS c� � t�j 1.,) ,4 ` <br /> LEGAL DESCRIPTION(see tax receipt) A n-A <br /> n_ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 0 <br /> c <br /> TYPE OF PERMIT(S): � <br /> n <br /> FILLING/GRADING ❑ CAM [G NIT ❑ „SUBDIVIS <br /> STRUCTURE/ADDITION USE: <br /> ( me/Cabin; Commercial Business; edroom; Deck, etc.) m <br /> ��BUILDING CONTRACTOR: �ag N �F:E L <br /> v <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. m 4- <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) OT n <br /> n v 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 m <br /> NORTH(N). CA 0 o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m o <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. 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. <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 ?. <br /> MUST BE SIGNED AND DATED BY THE OWNER. '0 0 <br /> � � I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> This structure to be used as private residential 0 �' Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. garage/storage only. Net to be used for humaD d, <br /> CONDITIONS OF PERMIT: <br /> habitation. <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. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA...L <br /> s. I S J I ^e LW.D� �Or �i^�v �6 cc�e7 <br /> Ce-SSoa?1 c.-Lc> 3E m <br /> Q 11 L� ,/� /( a _. = i c 0 0c a A <br /> V 0 t'l�y lcQer i�l o� Camra "5 o� = y o 3_ <br /> Ur �, Z C N l\O J 10 <br /> 'S-c V•-f hE S I ✓/Ir \ /./�G� I- �uiL.I I� 0 N : T', ,m <br /> I declare that this applic ion (including any accompanying schedule) has been examined by me and to he best of my <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of 1 i ? E m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 m Q <br /> providing in this appll ion. I agree to permit county officials charged with administering county ordinances or other ,o [ <br /> authorized person t e access to he above described premises at any reasonab f n. T m ' o. <br /> m D ; <br /> L1 <br /> SIGN HERE v+ <br /> (signat of owner or b i contractor) (date) 0 <br /> ZONING ADMINISTRATOR G i» sv Fn <br /> O N O W N ti t O <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY <br /> THIS PERMIT SMALL EXPIRE ONE YEAR ROM DATE OF ISSU$WWNG <br /> def + �e,rrrut SP�� ��W <br />