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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator _00 Z <br /> APPLICATION FOR LAND USE PERMITS 0. <br /> w <br /> OWNER / ! ). / TELEPHONE <br /> m <br /> O <br /> MAILING ADDRESS <br /> r m <br /> /n o <br /> PROPERTY ADDRESS Wj ki <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 3 <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 11ADDITION CL <br /> o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> STRUCTURE/ADDITIONUSE: � � /� aU 0 v+ <br /> ( me/Cabin; Commercial <br /> Business; Bedroom; Deck; etc.) w i h <br /> /� yr )f 22 Cz .� l/'t'7;ria jtt <br /> BUILDING CONTRACTOR: 62e at I <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO <br /> � H O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> TM Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). CO) ` "tom <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B 0 <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELO(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS, LAKE, LOT LINES. n, <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N J Zr <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. a o , <br /> v � <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. Z ' <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT p <br /> ISSUANCE. h -"j <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �l <br /> PERMITTED. \\\\ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 1 <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential M Q r a v a v <br /> 6. garage/storage only. Not to be used for human 9 3 3 9on 9 R m <br /> habitation. m N y y <br /> 7. Z m m o . <br /> o TSE M <br /> 1 declare that this application (including any accompanying schedule)has been examined by me and to the best of my D <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n ; C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �? o ` G <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ;J <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 <br /> authorized person to have accesm c �i <br /> o e above des ribed premises at any reasonable time fftor the purpose of'in/spection. y_j o <br /> CD <br /> SIGN HERE <br /> (signatur I owner or WildingM <br /> or) (date) a <br /> ZONING ADMINISTRATOR l � /(/ F 'tj E <br /> e 1p 0 TOWNSHIP PERMITS MAY BE REQUIRED <br /> gv� 'J THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v' <br />