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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3 0 0 <br /> APPLICATION FOR LAND USE PERMITS N r <br /> / up <br /> TELEPHONE v <br /> OWNER <br /> _ " o <br /> MAILING ADDRESS ,2 7-5-Vrie/4 I 'T RD WEB STRIP <br /> 0 <br /> PROPERTY ADDRESS 51/7)1 F-- 07711 tJ <br /> sc� �� U <br /> LEGAL DESCRIPTION(see tax receipt) ,�OT � 17 0L ❑ <br /> ti o <br /> DWELLING/BUILDING [IGARAGE/ACCESSORY STRUCTURE ADDITIO 0 <br /> TYPE OF PERMIT(S): <br /> FILLINGIG ING ❑ CAMPING UNIT ❑ UBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: <br /> k4i-lome/Cabin;Commercial Business;Bedroom;Deck;etc.) v <br /> BUILDING CONTRACTOR: lit/ <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR TO 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ; <br /> 0 CDn <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n v Y Z� <br /> m <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> rn n <br /> CA o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO <br /> M <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF U i o <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 /> INDICATE IF A WALKOUT BASLI <br /> BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. e o <br /> 5. �lJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 2 <br /> o <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> W o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> 0 ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° 1 <br /> CONDITIONS OF PERMIT: <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 SHORELINE1, <br /> . {bJ <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 1 <br /> SETBACK AREA. <br /> 5. m W 0 0 M a f m <br /> c=LThis structure to be used as private residential a � c OD 0,SLy N o = 3 <br /> 6. garage/storage only. Not to be used for human <br /> n o <br /> 0 <br /> 7. habitation. <br /> y O2 c <br /> I declare that this application(including any accompanying schedule) has been examined b me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> CD : m <br /> M <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue apermit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> m Cn <br /> authorized person to hav access to the above described premises at any reasonable time for the purpose of inspection. -n m : <br /> o - 03 <br /> SIGN HERE (date) <br /> (sign r o er or buil ontractor) <br /> ZONING AD INISTRATOR d'd'4A(A <br /> UN O (T (T OO <br /> TOWNSHIP PERMITS MAYBE. REQUIRED <br />