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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O <br /> H <br /> C <br /> �j N <br /> OWNER t TELEPHONE o <br /> CD <br /> MAILING ADDRESS D ('�( \�'� �� jy �l(.�����5 /V 'vY�9 f <br /> l'77 �'Fr <br /> � » <br /> PROPERTYADDRESS <br /> YMISd R ��J� <br /> LEGAL DESCRIPTION see tax recei 30L` w <br /> CD <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ m <br /> TYPE OF PERMIT(S): c ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: <br /> � b <br /> (Home/CabinCommercial Bu iness;Bedroom; Deck;etc.) . <br /> Ch <br /> _ <br /> m <br /> _ <br /> BUILDING CONTRACTOR: m <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. -n <br /> Jj <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OIn <br /> a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C \ o <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 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o I <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: 1 <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 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. <br /> This structure to be used as private residential m d r > o a v v <br /> 6. garage/storage only. Not to be used for human g 3 0. ; x a z <br /> habitation. z Nom, o N = 3 <br /> 7. o n m <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n in <br /> CL L� <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 0 : rn0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 w <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have ac ss to he above de ribed premises at any reasonable time for the purpose of inspection. MCD <br /> o <br /> o�s <br /> SIGN HERE d' <br /> (signe of ow er or building contractor) (date) a <br /> �: <br /> t � <br /> ZONING ADMINISTRATOR <br /> G40 4A 49 49 - N <br /> N N N N O O <br /> (/-rJ/ fTONN00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />