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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator _ o o <br /> APPLICATION FOR LAND USE PERMITS _3 <br /> r <br /> UT o <br /> m <br /> CD <br /> Yc <br /> OWNER TELEPHONE <br /> MAILINGADODRESS ��(�/� :: �Lj !r Iyl s+c_EZ �f <br /> r� m <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) S V3/�� �Ol L� L vti r m <br /> 7�� 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 00 ADDITION ❑ y 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o' ftr\ <br /> 2 <br /> STRUCTURE/ADDITION USE: 31 G fL 0 <br /> (Home/Cabin;Corlimercial Business;Bedroom; Deck;etc.) N <br /> t1 <br /> BUILDING CONTRACTOR: �1 �9 ( .Jy-txlss�t�� T�; r\ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 1' <br /> ILLEGIBLE PLOT PLANS WILL D. T <br /> M L <br /> m <br /> -n o <br /> T <br /> 21 Z <br /> ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n d A <br /> SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N <br /> SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF � o . <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. 0 <br /> INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Iv A <br /> IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <br /> TE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERT Oj(Tlgh MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �j n — Z W <br /> CONDITIONS OF PERMIT: 'QUp P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF ��C <br /> ISSUANCE. >�., <br /> 2. REMOVAL OR <br /> 3. NO GRADING OR HIO ELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY LIIlE1 J/v/OF TREES AND VEGETATION IS RESTRICTED ALONG N oVNTy Q <br /> �7QN <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential m d r> o a F m <br /> 6. garage/storage only. Not to be used for human $ 3 n" ` a <br /> habitation. a m W N ^ o 3 <br /> 7. Z mp : mo =t <br /> o M <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my — O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n f» C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m 0 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `D <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 n0 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. mco cn : <br /> o : <br /> m m <br /> SIGN HERE � <br /> (sl atu o ow wilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> /} NN O <br /> fA fA(AN <br /> r�7yB � N(T0 <br /> � a � � oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED r o16d <br /> ,bid <br />