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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y O Q <br /> OWNER TELEPHONE �! J/L < r GJ 4n N <br /> 0 <br /> m <br /> MAILINGADDRESS �d0 / �h <br /> O <br /> 7 Gc/s v� ('� <br /> f) / t <br /> PROPERTYADDRESS �f�3�P L� £/r� RY, Lc/ler OJJfh l�JT J7p Ci3 <br /> LEGAL DESCRIPTION(see tax receipt) Sf t y F I Z) <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRAD NG ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �' <br /> STRUCTURE/ADDITION USE: jr ° <br /> (H a/Cabin; mmercial Business; Bedroom; Deck; etc.) cn <br /> BUILDING CONTRACTOR: <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> Onsrle OkC�C pz <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. I 9 <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. r <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 : �J <br /> MUST BE SIGNED AND DATED BY THE OWNER. C 000 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z �) <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 O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> S�!ETBAC AREA. <br /> 5. G {l1Q7D� /L �cSMUCS U-�/YIR fe,-ho t Old -6114-0 Q(i9111ct� �'aGlX.lh f{>�L> YfA <br /> o f{IC, /((1��1 CA-bin, Q Q� m m W r DODO rn <br /> .� ro�/n 1�,50 from flte OftttJM Of Bt�[�,Ts l4ri.l ° g g f m <br /> 6. m �c <br /> This structure to be used as private residential a o� c N N o 3 <br /> 7. garage/storageGonly. Not to be used for human o , 0 M <br /> I declare that this application (including any accompanying habitation. 0-ra3 <br /> G) v : C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m n : c <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize `�: m c nto <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m : rn <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 0 <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person ve access to e above described premises at any reasonable time for the purpose of inspection. CD <br /> T a <br /> CD Di <br /> Q l m <br /> SIGN HERE <br /> (si ature of owner or building contractor) (date) 0 <br /> ZONING ADMINISTRATOR l'aC. coo <br /> �B <br /> c yi v+is <br /> f�fA EA fA fA� N <br /> O N (T W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> TH S PERMIT S7A- EXPIRE�ONMYEAR FROM _ _�X)�ANC� <br /> �e�mt� e ma!�Qa 'T; �yyt q- -D� <br />