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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION FOR LAND USE PERMITS < ` <br /> N j <br /> N <br /> CL <br /> OWNER <br /> 1� ��� �a� pL.r0. �. TELEPHONE /0 m ...� ' <br /> MAILING ADDRESS a TL9 5 r (Y ( C� v o m <br /> PROPERTY ADDRESS :f)&M'17 e.T S 1 ren (N T \ ~ <br /> P <br /> /rig/ R!oaacre,5 �+.yr`v+o <br /> LEGAL DESCRIPTION(see tax receipt) _ � _ <br /> ��}} <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE IBJ ADDITION <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADIN ❑ CAM ING NIT SUBDIVISION ❑ <br /> /� <br /> e Q!1 �al�lG9 2 <br /> STRUCTURE/ADDITIONUSE: OhI !�� ' <br /> ome/Cabin;Co ercial siness;Bedroom;Deck;etc.) � <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN W12 X 11 SHEET OF PAPER. ANY INCOMPLETE OR ,n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> � o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> o <br /> NORTH 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m n v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF pv`` z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. N 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. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS <br /> CNI MUST BE SIGNED AND DATED BY THE OWNER. ° f 1 <br /> WHEN <br /> MOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE111 2 { <br /> NiWDED. i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 'wH pz <br /> CONDITIONS OF PERMIT: 'I8 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS'9ANvr�C <br /> ISSUANCE. >p� Iqr,OVNT' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHO?CWRVG + 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, TC.,�WED)VIT IN THE REQUIRED WATER <br /> CKAREA <br /> 5. SE Se 1 � E'1 V ``//��//J)// m d r E m <br /> 07 OGL 59 z n aoaoa <br /> damn <br /> 6. ",,II �r-/ s $ 3 0 <br /> e oils,je- 6� r,Lc a� o1?��T� w/ ��� �O a�s� 2 R o y 3 <br /> = m : . . A <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my ` <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m o M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G: <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 <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. m m o <br /> CD B : <br /> m <br /> SIGN HERE <br /> a : <br /> (signatur o n b g ac (d e) <br /> ZONING ADMINISTRATOR6q <br /> 11�d,to6SMw N <br /> N <TN NOO <br /> cT O Ln Ln OO <br /> T WNSHIP PERMITS MAY BE REQUIRED <br />