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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 64872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N O ` <br /> OWNER k tV r I ES ItJ AY 16 t3-t /�L `P TELEPHONE a(Q �4443 - 3446 _o � <br /> MAILINGADDRESSOva l <( ,j �1�I /�(p�� l ° <br /> o <br /> PROPERTY ADDRESS <br /> g 3 Z, pp0 LA., e. (� ��rJ (t ter <br /> " I <br /> LEGAL DESCRIPTION(see tax receipt) Seem ON Yto P. q0 Qa is P0,FRL- Vw%cl I c <br /> b CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION In ° <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING_UNyI .❑ SUBDIVISION ❑ <br /> STRUCTUIRE/ADDITIONUSE: 0 <br /> w'/ YIK�� �Q p (Home/Cabin;Commercial Business;Bedroom; Deck;etc.)q d <br /> BUILDING CONTRACT R: 1 MA Y r I S �I?d S ni oss Y A p <br /> P11,aw -5)46- '1 ss cvE. �s�€Y S 8g3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> �I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT n O <br /> -n a Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. R <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m M <br /> n <br /> NORTH(N). to O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO v <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 (> 0 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. (fJ ° <br /> ` v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATQrE <br /> V C N o <br /> NEEDED. �CONDITIONS OFTHIS PERMIT IS S ERM TT TO ALL CONDITIONS LISTED BELOW. t�tD <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERK8U <br /> RN 7T <br /> 2. EMOVAL OR CUTTNG OF TREES AND 3. N GRADING OR SHOIRELAND ALTERATIONS ARE I ALLOWED ON IS TUNLESS SPEC F CALLRICTED ALONG YLINE. 2QA,/cG UNTy <br /> PERMITTED. I Y C <br /> /V <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA <br /> 5. G`y'y�. B' 03 � ('e - 7b SSS c�e� <br /> X w <br /> r O a <br /> m <br /> 6. <br /> a. m 0, ° m <br /> ry C <br /> Z N N ° <br /> 7. O T.G : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the 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 and accuracy of n O �9 <br /> PP (including Yaccompanying ) g <br /> all information contained in this application Includin an schedule and I further declare that I recognize m ; o me <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 d <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. o : <br /> CD <br /> SIGN HERE /'; 9" O3 r n <br /> Cj (signature caner or it g contractor (date) <br /> ZONING ADMINISTRATOR <br /> fR d fRO N <br /> N V• N O <br /> 1 O O (l O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />