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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N <br /> N <br /> C <br /> OWNERifut QA j TELEPHONE (G(2) Z�—' t n <br /> o t ,1 <br /> q2G Qum Ae15. A4, C` <br /> MAILING ADDRESS � �d � O <br /> PROPERTYADDRESS J , U Ave /61.-UC �jL, 4r 1 <br /> kkkkkk <br /> LEGAL DESCRIPTION(see tax receipt) L6f <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE E ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): c ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �' <br /> STRUCTURE/ADDITION USE: f((%X a l) c <br /> ( ome/Cabin;Commercial Business; Bedroom;Deck;etc.) (n <br /> w <br /> 'ks — <br /> BUILDING CONTRACTOR: <br /> v <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 v <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Oo <br /> m <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m fD <br /> NORTH(N). C: <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE,LOT LINES. C.�" <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, BUILDEf� TOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. / o <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE�( FICATI D o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Ju o <br /> CONDITIONS OF PERMIT: eU p 8 Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER�Tj�� CCU <br /> ISSUANCE. '�+131/N NTy.' �A1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C <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. � ti This structure to be used as private residential A v r D v D v v <br /> (7'�- garage/storage only. Not to be used for human � 3 n> 0 a 0 -0 <br /> 6. <br /> habitation. v N N o 3 <br /> 7. Z .0 00 = 00 =4 <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ' C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of d <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m i m <br /> that this information I am providing will be relied upon b the County of Burnett Wisconsin in determining whether to Is- <br /> sue <br /> P Y tY 9 ^� <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 described premises at any reasonable time for the purpose of Inspection. o <br /> CD <br /> SIGN HERE <br /> (signatureof caner ilding contractor (d e) <br /> :) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED 1 <br /> r <br />