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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS <br /> 4J <br /> OWNER <br /> !2710 V l^J �CcoD t TELEPHONE RG- 7q0-5 <br /> m <br /> n <br /> MAILING ADDRESS f <br /> CD <br /> t 4 L T7 i CD <br /> PROPERTY ADDRESS <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) L9 81,r Sv <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ADDITION ❑ Q p <br /> TYPE OF PERMIT(S): 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> ��x <br /> STRUCTUREIADDITIONOSE: 38_ o <br /> Horr)e bin;Commercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: <br /> A - � <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) <br /> Om <br /> n c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m D <br /> NORTH(N). 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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I (oz <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O 1 <br /> BUILDINGS,ROADS, LAKE,LOT LINES. j\ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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 /> l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � o <br /> NEEDED. ppO` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z Q N <br /> CONDITIONS OF PERMIT: o r vl <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT i <br /> ISSUANCE. y` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHO <br /> PERMITTED. RELINE. l� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER d <br /> SETBACK AREA. <br /> 5. <br /> 6. <br /> CD W 0 (D CL M <br /> " 3 am Fam <br /> CD. <br /> 7. m cy o <br /> Z mm O ; ''O =1 <br /> o : =0 ` M <br /> 1 declare that this application (including any accompanying schedule)has been examined by me and to the best of my zi z : <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m cc, in C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I reco nize <br /> 9 \ mC of M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- E <br /> Is- <br /> sue a permit. I further a ept all liabili which may be a result of the County of Burnett relying on this information I am <br /> providing <br /> p g in this appli on. I afire permit county officials charged with administering county ordinances or other o '• <br /> authorized person to a acces o above described premises at any reasonable time for the purpose of inspection. m s <br /> 'T' o <br /> SIGN HERE /� C� m l E <br /> i <br /> (signs 1-2 <br /> a of ne or building contractor (date) ' a <br /> ZONING ADMINISTRATOR <br /> r\ H fA fA fA�N <br /> Ncn <br /> 6 <br /> TOWNSHIP PERMITS MAY BE REQUIRED N o ra NK) OO <br /> 0 0 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />