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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Admini trator v Z <br /> APPLICATION FOR LAND USE PERMITS <br /> 6 <br /> OWNER o <br /> �/ O <br /> Vl�l/J�r'`�v t j TELEPHONE <br /> o- <br /> HOME ADDRESS <br /> M <br /> r m <br /> EMERGENCY/FIRE NUMBER Q�v ROAD NAME o <br /> LEGAL DESCRIPTION (see tax receipt) <br /> L I CMV /4 -P33 Gov [� 46 � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ 0 o' <br /> TYPE OF PERMIT(S): C <br /> v <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ °- <br /> STRUCTURE/ADDITION USE: > <br /> (Hom Cabin; Comm cl I Business; Bedroom; D etc.) N <br /> JJ ] 1 ) � <br /> BUILDING CONTRACTOR: Dom �!'2��)-) 2- <br /> A <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n - <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o. C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. -n �A <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 m -N, 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ` 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. 1 C� <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. �' o <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Cl <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 4�1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER l� <br /> SETBACK AREA. <br /> 5. 144do'C <br /> .L/ U/ ;o -0CgD0D0 <br /> lv f ms. J <br /> COO OX <br /> This structure to be used as private residential -a CID C N " o 3 <br /> 7. Z N O : (O <br /> garage/storage only. Not to be used for human o : -n <br /> : <br /> - � : <br /> I declare that this application (in habitation. iy me and to the beA <br /> st of my �j , <br /> knowledge and belief it is true, correct and complete. i acKnowieage inat 1 am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 5\ C m <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- l7 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to he a access to the above de r' ed pre lees at any reasonable time for the purpose of inspection. m <br /> m : <br /> M <br /> SIGN HERE <br /> (si a of owner or building contr ) (date) <br /> t <br /> ZONING ADMINISTRATOR <br /> NSHIP PERMITS MAY BE REQUIRED �31 I <br />