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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N O <br /> 41 <br /> C <br /> OWNER AA�p,A o. _ <br /> yTELEPHONE 7 2V <br /> U <br /> HOME ADDRESSWAV <br /> Uu <br /> EMERGENCY/FIRE NUMBER 3 ROAD NAME �C% /�%lam( '�✓ l <br /> LEGAL DESCRIPTION(see tax receipt) cn <br /> DWELLING/BUILDING^ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ I N 0- <br /> TYPE <br /> TYPE OF PERMIT(S): �h p A�/Il rr <br /> FILLING/GRADING CAMPING NIT ❑ SUBDIVISION a <br /> S. <br /> STRUCTURE/ADDITION USE: o <br /> (Home/ Commercial Business; Bedroom; eck;a .) C <br /> BUILDING CONTRACTOR: it <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR M <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> O ir1 <br /> XI y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> n C <br /> Z! Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m IF <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 W <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> 10 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0t <br /> NEEDED. / 9 �Q ! W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. / 15 � 9s �cf�re �h/ JGQ/ o <br /> CONDITIONS OF PERMIT: .I� /, y WW��" �� 1 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �// r d <br /> ISSUANCE. N® QC / Q'046 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. pe,yyi1-4 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5. L(/ <br /> SETBAC AREA. /` <br /> $tee /b�— w,1, — �f Gflu//rr�ry Ooh r o g o <br /> 6. m . m = m m <br /> ,�,I l ) � � 3om �c70 <br /> �C{�J ((eox r� �Kr3ri�+qS�' d�LA/�c.�a� o � y `" <br /> /v P <br /> 7. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ( p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 c <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize ( m m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- "f O <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person have access to the above describo premises at any reasonable time for the purpose of inspection. CD <br /> m <br /> m : <br /> 7aSIGN HERE w <br /> (signature of o er r ildin contrao f te) <br /> ZONING ADMINISTRATOR �/ 2 <br /> Qv+�n�n�n�naa�' <br /> d N N 0 0 0 <br /> N N0 P 0100 <br /> TOWN HIP PERMITS MAY BE REQUIRED D0 0 0 0 <br />