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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator -0Q Z <br /> APPLICATION FOR LAND USE PERMITS 2. <br /> CDOWNER / TELEPHONE C <br /> MAILING ADDRESS �v C7 / C� CJ�/`� •�+S Io , y /,�/� v (�Q O <br /> J � <br /> PROPERTY ADDRESSo�O J S 7{a�t l'�C/l Y t <br /> LEGAL DESCRIPTION(see tax receipt) (f rn <br /> I � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORYSTRUCTURE ADDITION ❑ 3 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CA ING UNIT ❑d SUBDIVISION /,.., a <br /> ITION USE: �Ur wSTRUCTUREADD7 <br /> i <br /> o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.)_ � <br /> BUILDING CONTRACTOR: Q '--' � 2 <br /> U z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR (D <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 <br /> W C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> CL ppp <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. -6 Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m 70 <br /> NORTH(N). C <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),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 OR FILLED. N <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. o <br /> a E I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATyOt� 7 '� <br /> E DONE WHEN o <br /> NEEDED. j(/ �� l '5THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. C /; r Z <br /> CONDITIONS OF PERMIT: r ti (//�/ o ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE/ IyIIT Oct 8 Jul' J <br /> ISSUANCE. ((JJIlQQ//���� oo� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIN 7) <br /> 3 NOPERMITTED.GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY zOA,�AC(,®uAV q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WAVTN ' /IVJ <br /> SETBACK AREA. <br /> 5. <br /> / This structure to be used as private residential M o r D O D o IV <br /> 6garage/storage onl . Not to be used for human 0 °' o 0 a m <br /> Y m 3 CL(OD x � - r. <br /> 70 <br /> 7. habitation. z y m y <br /> TIS M <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my i E D <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w n ; d, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize E m E i o E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- D <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 <br /> providing in thi plication. l2pree to permit county officials charged with administering county ordinances or other m <br /> authorized so c to a ribed premises at any reasonable time for the purpose of inspection. m Cn <br /> mo : <br /> SIGN HE E /Q CJ 3 m <br /> i <br /> ( a rs of owner uilding contracto (date) '• a <br /> ZONING ADMINISTRATOR 1�-7} <br /> TTV� ,V �� � N 0 N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />