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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 3 <br /> 0 (1 <br /> m ° ,XJ <br /> N <br /> r•1 II� �f q c� t� C <br /> OWNERTJ. w i l�1('�i/Y11V�4 1 ` SG'��t^ TELEPHONE 7�j' SJS' 1 1 13 v W <br /> �/ `` 7 `rB�WlC' CD O— <br /> HOME ADDRESS33ll � dfn 0.k ��QLII�e � �1r S 1 `01 <br /> o CD <br /> J <br /> EMERGENCY/FIRE NUMBER -1 �q 1 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) P� �_ V�1 (�j (-p <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE W ADDITION ❑ PRIVY ❑ N ° <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ p �. �- <br /> STRUCTURE/ADDITION USE:3ZX3V (` <br /> D �Q� (H(�ome/CTabin; Comme ial Business; B droom; Deck;etc.) m <br /> BUILDING CONTRACTOR: 1 , �-�Jw�.�Co� lL � � - <br /> 1 <br /> v <br /> CD , 1' <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR n Lo <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> z m QCi <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 0- <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. LJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. I f <br /> CONDITIONS OF PERMIT: �RMIT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF R ` 000 <br /> AP C <br /> ISSUANCE. RUWV <br /> SHO - <br /> 3. NO GRADING OR H2. REMOVAL ORIO NG ELAND A TERATOF TREES AND I/ONS AREIOALLOWEDTRICTED UNLESSS SPOEC NG F CALLLY E I ' �'�UIVTy <br /> PERMITTED. ZOI0NG r.( <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (((fff <br /> SETBACK AREA. �� / <br /> 5. VVX � C) v DODOS <br /> CD� �gLuv� � f m <br /> pr��f�- Arco, / � 3 <br /> I declare that this application (including any accompanying schedule) has been examined by me and tote o y ' G) c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize ` <br /> (� 9 Y ) g `� m p <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 ai ree to permit county officials charged with administering county ordinances or other <br /> authorized person to tVve acc to the above described premises at any reasonable time for the purpose of inspection. -n ° <br /> m <br /> m <br /> SIGN HERE <br /> (signature of ow oruilding contractor (date) <br /> ZONING ADMINISTRATOR 1 ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />