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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> VT o <br /> . TELEPHONE 63 m MOWNER uO <br /> MAILINGADDRESS SS� AV. palhCQo4i 47A/ � S-3 C , <br /> J- q <br /> o \\ 1 <br /> PROPERTY ADDRESS <br /> _ Lo-� s Csrn3Y7/ l/oJ zo 279 <br /> LEGAL DESCRIPTION(see tax receipt) I <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION U <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: rg o / i� <br /> . Home/Cabin, Commercial Business; Bedroom; Deck; etc.) ? <br /> BUILDING CONTRACTOR: <br /> aJ1 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/,X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Q <br /> 4b 6Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> m Q' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). N <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. ° <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. <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 j, o t <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> o D <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> n <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 Q <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_ Alt OWFn WITHIN THF RFOI IIRrn WATER <br /> SETBACK AREA. This structure to be used as private residential <br /> 5. 10 <br /> garage/storage only. Not to be used for human X W W M 0 o a o m <br /> 30 CLz <br /> s. habitation. o � c N 0 3 <br /> o v m 0 <br /> o CD �� : M <br /> 7. i m <br /> i»: IC) <br /> I declare that this application (including any accompanying schedule) nas 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 1 am responsible for the detail and accuracy of - A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other j <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T n <br /> m a <br /> SIGN HERE �� �/7/ S-z 7 0 57 a <br /> ' '(signature of owner or building contractor) (date) D <br /> ZONING ADMINISTRATOR <br /> OO (T O (T CT (T O <br /> TOWNSHIP PERMITS MAY BE REQUIRED G <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROIO DATE QF ISMUANE��I <br /> pmt+ lUf-�� �a'rtitf lr) <br />