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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 . <br /> Q> <br /> OWNETELF_PHON (U <br /> CD O" <br /> MAILING ADDRESS r Y <br /> 0 <br /> o <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) 14)a) ,St4l <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE bg ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION <br /> a <br /> STRUCTURE/ADDITION USE: �Qq� tf/ x S 0 <br /> (Home/Cabin; o tial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: m <br /> Z � <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p y h <br /> M N Ile <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) r n <br /> ?I v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 9 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). W o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <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. o <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. d <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 -4Z7- <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION w <br /> NEEDED. / <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: OL I 6 I QN <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT L'fURNE� �� Z/ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ZON�N oVN <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C7 V <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. This structure to be used as private residential m m m>0 a f m <br /> 6. garage/storage only. Not to be used for human m. 3 a m F D M <br /> b g g Y' 'o <br /> 7. <br /> habitation. � w W E 7, a <br /> Z <br /> yTc m <br /> 3 <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of my <br /> ^� ' O <br /> PP ( 9 Y ) Y L7c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that i am responsible for the detail and accuracy of i m o : v,: <br /> : CL 'j, ' <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m o :: mCDe <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> E LTE <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information 1 am m E <br /> providing in this application. I agree to permit countyofficials charged with administering county ordinances or other <br /> fo ' <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. 1) o <br /> SIGN HERE ' <br /> (signature of owner or bL44ng contractor) (date) <br /> ZONING ADMINISTRATOR <br /> fA(9 fA�+N <br /> O Cn 0 (Nn (Nn O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE Mttl I{ <br />