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Burnett County 7410 Co. Rd. K, No. 102,Siren,W154872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> m O <br /> H <br /> C <br /> OWNER [/� DLGL�� TELEPHONE 7 6 3-- - <br /> p,�Q Y ' p) m •N <br /> MAILINGADDRESS 3(nC� � CI�S�� 57-' /"�• ��G u`!lljl /7 M� <br /> r � � <br /> 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) Q-7 d-JoZ, — 5-3 a-6-- nt—90-D <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE DDITION ❑ CO <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVICSIPN ❑ <' <br /> ° <br /> STRUCTURE/ADDITION USE: <br /> �� (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) C <br /> y <br /> BUILDING CONTRACTOR: / &'A J <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> .RI N �- <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(N). N 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn o <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. I P <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q� <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. 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 0 <br /> 4 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN » V 1 <br /> NEEDED. » <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (roe <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACEA. <br /> 5./li7�1p` J This structure to be used as private residential <br /> A nrDODOM <br /> garage/storage only. Not to be used for human 3 ' 8 g a c m <br /> 6. habitation. o '� <br /> ry C y y 0 3 <br /> 7. Z N O O -� <br /> O n rrn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myp 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 d � .n <br /> 0- <br /> all v <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize mC o my <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- CD� <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 access to the above dCO <br /> d premise ata reasonable time for the purpose of inspection. o : <br /> CD <br /> CD <br /> SIGN HERE -31e y 'a <br /> (sign ure of o r buHding nt ctor) 4 (date) [ <br /> ZONING ADMINISTRATOR Q �, <br /> fA fA <br /> NNN <br /> fON <br /> (T OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED (V{{ <br />