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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> CD <br /> /> �7 1/`7 / f/1 <br /> OWNER K 7 tZ �lLx u yy1 TELEPHONE C/���a 773`3 afO s a <br /> v_ <br /> HOME ADDRESS Gun �. L v h It�iA 'jut: 67Y6 <br /> r m <br /> EMERGENCY/FIRE NUMBER 2fo��� 60, X 1/.S�F#&41ROAD NAME U ' o <br /> LEGAL DESCRIPTION(see tax receipt) <br /> u n n v5i)IIE n hDa1tQy\ s c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE XADDITION ❑ PRIVY ❑ to O <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING^❑ CAMPING UNIT ❑ SUBDIVISION ❑ L1 <br /> STRUCTURE/ADDITION USE: G R►214�/f (o (o <br /> N <br /> 0 <br /> IlHome/Calbin; Commercial Business; Bedroom; Deck; etc.) ti <br /> BUILDING CONTRACTOR: if Gl�ff � <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE O 0 <br /> T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ae <br /> ��(J <br /> (/U O <br /> fl m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) �� 5� O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a R� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). y 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. O <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. (J, <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 F <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN T 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: �� ,, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT !i{ �� �U <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 ���� G C? <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATE+ s <br /> SETBACK AREA. Q <br /> a <br /> e. This structure to be used as private residential \\ �J r D D m <br /> 6. garage/storage only. Not to be used for human a : CD c CD <br /> habitation. - N o : ° o _j <br /> 7. o CD <br /> c � A <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my G> c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of I jj,: n 2 <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize PP ( 9 Y ) 9 `D @ p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- I <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 <br /> providing in this applicatiojV I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to ha a ss to th bove described remises at an reasonable time for the purpose of inspection. m <br /> p P Y P P -n <br /> (D : <br /> C <br /> � m <br /> SIGN HER ! d <br /> ign ure o r building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> RJ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />