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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator �(/ /bl.� 'Z� <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> UT <br /> y 0 `\ 1 <br /> O xJ <br /> N <br /> C <br /> OWNER O TELEPHONE o <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 07 O o Z - 0/44 �> <br /> LEGAL DESCRIPTION(see tax receipt) 2J= �Z .20_ _y�,6���0 s xs c, <br /> 1 m <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORYSTRUCTUREXI ADDITION ❑ PRIVY ❑ © o <br /> � � <br /> FILLING/GRADING ❑ CAMPING UNIT 11 SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE:� �1G0� LtiAY�f T/JOG o <br /> (Home/ ab' C iffiercial Business; Bedroom; Deck; etc.) C ' <br /> BUILDING CONTRACTOR: <br /> m <br /> CD <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m _ <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) M <br /> O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> m m <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 -o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <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 1 N y1.OJ <br /> 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. --I <br /> o ? I <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. Z r <br /> CONDITIONS OF PERMIT: p <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential X -0 d r > o a f m <br /> 6. garage/storage only. Not to be used for human g a a 2 a ( z <br /> habitation. -a c N " o <br /> 7. o y m0 _m <br /> T <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Cc <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m - m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- c h - O <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 i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other � <br /> authorized person to have a <br /> ccoss to the above described premises at any reasonable time fdr the purpose of inspection. m <br /> I <br /> ID <br /> SIGN HERE <br /> (sign re of wner or bu' g ntract r:. !(date) JCS <br /> s <br /> ZONING ADMINISTRATOR ,p> <br /> TOWNSHIP PERMITS MAY BE REQUIRED `7 <br />