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BurnettCounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. =- \n1 <br /> N ti <br /> OWNER �' L �S Jul <br /> ` TELEPHONE <br /> � <br /> MAILING ADDRESS / Lu, 11 i; <br /> CD <br /> PROPERTYADDRESS 5A m E \. <br /> qQV30Liv <br /> Q - �UbOi US76U I•T5A <br /> C <br /> le�s <br /> LEACRPV0N�ejx receipt) '�C ' / 81, LC7 I4Z O (D <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 2q ADDITION ❑ cn ° <br /> TYPE OF PERMIT(S): ° <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �' <br /> STRUCTURE/ADDITION USE: <br /> C r' (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> v <br /> m <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. m <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a G <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 6 � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N ` o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. A <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. p C� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 IN <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. v� 1 <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> (tq� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � 1,11 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 2 J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. Uy <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> ETBACKAREA, <br /> 5 r <br /> It e- �r This structure to be used as private residential ; 0 r > o n o v <br /> fm <br /> 6. garage/storage only. Not to be used for human I; 3 a 8 `s a `° ;u <br /> habitation. a m c y y <br /> Z o 3 <br /> 7. 0010 : <br /> Tom : M <br /> = � m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m c`, v, C <br /> n i : cn : M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m : o : my <br /> that this information I 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 rel inu on alis information I am m <br /> providing in this application. I agree to permit county officials charged +witt118t rinances or other <br /> authorized person o have access to the above described premises at �' h se of inspection. fD o <br /> CD <br /> ��Z `7</ /,* 4 " <br /> SIGN HERE <br /> n : <br /> (signature of o r building contr c r) YK — 7 ate) <br /> ZONING ADMINISTRATOR d �, <br /> N N N N O O <br /> TOWNSHIP PERMITS MAY BE REQUI 0 jggo I C (� <br />