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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U o Z <br /> APPLICATION FOR LAND USE PERMITS 3. cKXJ <br /> rn O <br /> CD <br /> TELEPHONEOWNERKFf3M14- LAg5on ' —Y fG ID17CD <br /> N O <br /> v <br /> MAILING ADDRESS L <br /> m <br /> PROPERTYADDRESS SQ WN .( 1 <br /> LEGAL DESCRIPTION(see tax receipt) Q C L p t-o+ 41 <br /> � I <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE 22�ADDITION ❑ rn <br /> TYPE OF PERMIT(S): C a i <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUB VISION ❑ Q 1 <br /> s � 4p x �a 1) N <br /> STRUCTURE/ADDITION USE: G r �G { 0 <br /> (Home/Cabi ; Commercial Busi ss;Bedroom;Deck;etc.) <br /> BUILDING CONTRACTOR: D W ►'1 `C V� G <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> -n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE AS <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 3 <br /> 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. ° <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 /> 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. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <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 <br /> SETBACK AREA. <br /> 5. ,�/� �. This structure to be used as private residential p n r- D o D o v <br /> V/ garage/storage only. Not to be used for human " 3 ' g Oaf m <br /> 6. �' 3nmx� fD � <br /> habitation. -o m C y y o g 3 <br /> 7. Z N ; o : =� 1 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 2 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of w a : :A <br /> o 2 v <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o M <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 relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ° o <br /> CDm <br /> d : <br /> SIGN HERE /Z— <br /> (signatu f owner or building co r tor) (date) <br /> z <br /> ZONING ADMINISTRATOR � to(„ <br /> " fA EA fA fA � N <br /> dWNSHIP PERMITS MAY BE REQUIRED <br />