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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administratoro 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> C <br /> ii <br /> OWNER306 a- Mary Mui lenheL�► TELEPHONE6SI-S7�-�3ya <br /> O <br /> HOME ADDRESS 3-7 V r� opo6UlA - 125- <br /> a r mP <br /> p 0 <br /> EMERGENCY/FIRE NUMBER a7S1a ROAD NAME Tl�erous— ►Say K/l. I ~ <br /> 136- 0- 15' <br /> rrII <br /> LEGAL DESCRIPTION (see tax receipt) <br /> r VoV t o+ a4-3 Sec 36— 0— 1 ' � v, <br /> m <br /> I <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ❑ ADDITION X PRIVY ❑ C!1- C o <br /> o <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> m' <br /> o <br /> STRUCTURE/ADDITION USE: UAM f- / <br /> (Home/Cabin;Commercial 13 iness; Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR:T 1 Ce A5 j rVC+, O iI (r>A <br /> R <br /> v\ � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O ^. <br /> M O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) In c. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N c <br /> NORTH(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 Ul c <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 ` <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 'ic <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 2 c <br /> MUST BE SIGNED AND DATED BY THE OWNER. b Oa 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z I <br /> CONDITIONS OF PERMIT: o G <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. °O Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHJED <br /> oo ` 0 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICA ]� <br /> PERMITTED.4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE RSETBACK AREA. T1 <br /> s. ,S a. -C� f 6�l/�t .— ' `J s :% IUUI 3 n <br /> ,.,��f��a m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to'thb+best of my L7 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Q ; , O <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. 1 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 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. - <br /> CD <br /> d m : <br /> / <br /> SIGN HERE <br /> signature er or building contra ) e) <br /> ZONING ADMINISTRATOR <br /> RN <br /> N� NNo� (n0 <br /> q0l3 o� o0 <br /> 6r 000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />