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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O � <br /> N <br /> C <br /> _ n <br /> OWNER TELEPHONE 7( S-- Q cco <br /> m <br /> MAILINGADDRESS O £O <br /> J <br /> n / r <br /> PROPERTY ADDRESS y Ir (� ;��✓ �Qitl 'i o G\ <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> \ g <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ (n o <br /> TYPE OF PERMIT(S): Iit <br /> IN ' \ <br /> FILLING/GRADG ❑ CA PIc <br /> � d <br /> �' IT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USEIn L ,a- , I, ' — 0� (Home/Cabin; Commercial Business; Bedroom; Deck; etc. < <br /> 1, <br /> M <br /> BUILDING CONTRACTOR: OA—A -C-L- <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. r <br /> 0C>- <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 O n <br /> � z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. CI m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). y _ 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 —4^ 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. V <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,0 5 I <br /> v <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 4 ^ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. S <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C) <br /> PERMITTED. d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. STrtte tU be tted dor V� SSS 6n A) allPA&h <br /> 6. U Ct:..C�Q� co m d n 0 a � T <br /> This structure to be used as private residential g F 3 a 8 x a A <br /> �a mm <br /> garage/storage only. Not to be used for human z g N o _ 3 <br /> 7. P A �� A <br /> habitation. e m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my : OC <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of �� [ d n v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m Si I m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- r Z ; in 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 m o <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other [ <br /> authorized person to have access to ttwlabove describ d premises at any reasonable time for the purpose of inspection. m [ n <br /> � D ! <br /> SIGN HERE ell f^ ` a <br /> (sig ur of owner uil 'n ontractor) (date) ( 1 0 i <br /> ZONING ADMINISTRATOR v l: <br /> O�d1 d1 EN(A� N <br /> O N (n W W N O <br /> Gauo � � u0 <br /> �/YLtTOWNSHIP <br /> �PERMITS <br /> LMAY <br /> IK,B/AE,./REQUIRED <br /> THIS VQS' L�, �PONE YEAR <br /> FROM <br /> AJOF �N�9-k6SD- (0 <br />