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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3 4 <br /> APPLICATION FOR LAND USE PERMITS <br /> N O <br /> CL <br /> OWNER (�WO - PPA,Lp- K i ss n er TELEPHONE <br /> `" 0 <br /> HOME ADDRESS t70,7 q 61 ab. Payu lnvvt.Gro✓-�- N s MIA r R <br /> EMERGENCY/FIRE NUMBERa�yq9 ROAD NAME,JC,y),�n Lakes/Zac W <br /> Lo+ a 0SM Vo 1 q, R� �� ,SOCti6 ) <br /> LEGAL DESCRIPTION(see tax receipt) ty Tin O f�gnCl Uf/LQ. o <br /> cl) o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Q ADDITION LI PRIVY U <br /> v <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMMP±ING UNIT ElSUBDIVISION ❑/ /' 5• <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> v <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR .n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. M C Q <br /> O m <br /> CL <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF oZ <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. N <br /> ED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNQ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2 o <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr w <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> P <br /> CONDITIONS OF PERMIT: _ 1 <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. IS RESTRICTED (J> <br /> 2. REMOVAL OR 3. NO GRADING OR SHIORELAND ALTERATNG OF TREES AND IONS ARE I AILLOWED UNLESS SPECIFICALLY RLINE. -SII <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. «�J �) S <br /> 6. /Q // T J6. <br /> m o i 7 9 3 <br /> o A <br /> 7. rIYGCCia� —_rn i m <br /> i E <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L3 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �� m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- t)+ m <br /> sue a permit. I further accept all liability which may be a result of the County a Burnett relying county <br /> this information I he <br /> am W;: <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access t the above described premises at any reasonable time for the purpose of inspection. <br /> CD <br /> a3-G-�o <br /> SIGN HERE (date) <br /> (sign re of o ner bull g rl 2�•�j�a <br /> ZONING ADMINISTRATOR <br /> N N PP <br /> 0000000 <br /> V7NN <br /> V1 (n 0(n 6f1 O O <br /> 0000000 <br /> TOrSHIP ERMITS MAY BE REQUIRED <br />