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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD- o0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> � E N a <br /> y <br /> C <br /> fD <br /> OWNER 4 f , ( TELEPHONE . 1 o <br /> �^ o <br /> MAILING ADDRESS 1I V I,k r '\\1 (?�/( C Amn�.V (Y\ A , CD <br /> PROPERTY ADDRESS <br /> L-) cSM V cot <br /> LEGAL DESCRIPTION(see tax receipt) ��. 2 ♦f /.) L 0 .� <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE [ ADDITION ❑ U) <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <: <br /> STRUCTURE/ADDITION USE: P) %-rG t p�• s 34 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> P.L" <br /> BUILDING CONTRACTOR: <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> N rj <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a �{ <br /> n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C C7 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO IM <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF a <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I Q <br /> BUILDINGS, ROADS, LAKE,LOT LINES. Pi <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o I <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 o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. (^^11 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I <br /> CONDITIONS OF PERMIT: <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. <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. This structure to be used as private residential <br /> 5. garage/storage only. Not to be used for human <br /> A W M W 0 O a M <br /> 6 habitation. 0 3 a g x a A <br /> 'O o CD C <br /> C ip N <br /> 7. O N T`C M <br /> = rn : : rn <br /> I declare that this application (including any accompanyingscneauie nas Dean exammea o me ano to the nest or m <br /> PP (� 9 / Y Y i ` � <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 361, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize J m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m rn `• <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 o <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. n cD o <br /> _ m D <br /> o a . <br /> SIGN HERE .. <br /> (signature o owner or building contractor) (date) 0 <br /> ZONING ADMINISTRATORy)M ILIA✓) v!` <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHAD EXPIRE ONE YEAR FROM DATE OF ISSUANCE'1p/I� <br /> 1 ((11 I 4 1R'+-kf ftvi 1,2Q'-�D RW-fibOfv-c Zn 8-8-0-'r D 1 <br />