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Z <br /> Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator M G) z <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> Cxj <br /> CD <br /> 0 <br /> OWNER r� TELEPHONE v <br /> m V' <br /> MAILING ADDRESS <br /> r m <br /> 0 <br /> PROPERTY ADDRESS 1A 56 C ' /tt Ad N 7 <br /> LEGAL DESCRIPTION(see tax receipt) �m �5 pc q GL7/r v( rtil <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> TYPE OFPERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o; e <br /> STRUCTURE/ADDITION USE: xdwa--j f A-y /3C jr .9 <br /> (Home/Cabin; Commercial Bu si ass; Bedroom; Deck; etc.) rn t <br /> m ^ 1 <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81f2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> >7 vi C <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) 0 o <br /> ?I o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m T jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C ;? v O <br /> NORTH(N). y (� 0 <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 <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. k-9 <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 PLANS0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,o 0 t <br /> v, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERI I N_MAY BED NE WHEN 0 <br /> NEEDED. f <br /> UP, 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. U o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS F PERp z <br /> A, t� <br /> CONDITIONS OF PERMIT: y R 9�j <br /> rt, <br /> MITI fes' <br /> ISSUANCE. �I������� p.�. rMll Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG"""""�Y'/ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLYPERZONdtiG U <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m pW0) 0imafm <br /> 7. v " o 0 0 <br /> = Cni m <br /> I declare that this application (including any accompanying schedule) has been examined by me and tote best of my G>c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail ar d accuracy of m 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare tt at I recognize (D <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (D <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this ini Drmation I am G r <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o E <br /> authorized person to hAV access to the above described premises at any reasonable time for the purpose of inspection. -nm o <br /> a - C�c.� m <br /> 49— / i m <br /> SIGN HERE <br /> tura oI ow er or building contractor) (date) ti ` 0. <br /> ZONING ADMINISTRATOR <br /> EA fA• N <br /> rn� ( TOWNSHIP PERMITS MAY BE REQUIRED <br /> Sg. () tTHIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE vj <br /> I <br />