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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administratoro 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> N <br /> �/{� �Q fDD r> <br /> OWNER Tit fJQW [� � V TELEPHONE <br /> Q <br /> MAILING ADDRESS 2.4 Q 7tv> <br /> W m <br /> 0 <br /> PROPERTYADDRESS -AM C <br /> LEGAL DESCRIPTION(see tax receipt) sY]e <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Ids ADDITION ❑ ~O <br /> TYPE OF PERMIT(S): d <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 7'-' <' <br /> STRUCTURE/ADDITION USE: ��ra G <br /> (Hom abin; ommercial BusinessoBedroom; Deck;etc.) U <br /> BUILDING CONTRACTOR: <br /> CD <br /> v I <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR ,n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> ZI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n <br /> 'nZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C n <br /> NORTH(N). fn ° <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. ° <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 QJ LLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, COIF C., THE PLANS o 0-0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC ION MAY B E " E, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. C 9?OO Z <br /> CONDITIONS OF PERMIT: BORNE p <br /> 1 ISSUANCE.VEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 2pNVNG UN7-y <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 ;a n r a a v -0 <br /> 6. garage/storage only. Not to be used for human a H C a <br /> m Ny <br /> h7. abitation. o a <br /> -n m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 : d,: <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD o : G <br /> that this information 1 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 w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person tq have access to the above diiscribed premises at any reasonable time for the purpose of inspection. m o <br /> m � <br /> SIGN HERE Gn 46� o <br /> (signs uhf 1fopr or building contractor (date) <br /> ZONING ADMINISTRATOR \gypyr e, <br /> Ncn NNOO <br /> l! (TOfI NOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 13 <br /> W"- <br />