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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> UT O <br /> N <br /> C <br /> Q N <br /> OWNER /3FI/�RRR/3 T PG TELEPHONE 7J5- �. ' - 7ct4oe O <br /> F nq-- '' ( '1T .,I,,-, m <br /> MAILINGADDRESS 3S3G, Gf) F /.som .S r• a6 C �/Q ll��-� SY'/ <br /> PROPERTYADDRESS 9jKL4h K -t<i+xE <br /> {.0 f 3 CSnm V4 P 334 (s>J Crc Let 5) r <br /> LEGAL DESCRIPTION(see tax receipt) r <br /> Nc.rc� /.Svc -sic /s �v ctizccID <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ U) <br /> TYPE OF PERMIT(S): 1 a <br /> FILLING/GRADING ❑ C MPING NIT ® SUBDIVISIO ❑ <br /> STRUCTURE/ADDITION USE:0 ' <br /> (Home/Cabin; Commercial Business;B roam; Deck;etc.) <br /> d <br /> BUILDING CONTRACTOR: <br /> U <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR B. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O 5 <br /> 57 <br /> z H r O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT a <br /> M Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO In D <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. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO p <br /> BUILDINGS, ROADS, LAKE, LOT LINES. 7(1a <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ry <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. ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN » ° 1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> VCR <br /> CONDITIONS OF PERMIT:1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PEIT I <br /> ISSUANCE. f r I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SH LINE. i J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. ^WING <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED COUNTY C <br /> SETBACK AREA. //n�1 <br /> 5. /'} LJ nOy— Jr/_ /`'(C'� C,�l� — m d iu > o a f m <br /> 3 CL <br /> 7. A in o o -i <br /> Z Tom : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of a » N <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m o my <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 y <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m c <br /> co <br /> (D <br /> SIGN HERE <br /> o- <br /> (sig ure of caner or fl g contractor) (date) vQ� <br /> ZONING ADMINISTRATOR �� <br /> df fACrldi� N <br /> y (TNNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED ��V�1 <br />