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Office of Zoning Administrator _U o 0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 3 0 <br /> APPLICATI N FOR LAND USE PERMITS o <br /> N <br /> C <br /> tD <br /> d <br /> TELEPHONE —v / <br /> OWNER <br /> O <br /> UC �4a CA <br /> MAILING ADDRESS 0 <br /> 0 <br /> PROPERTYADDRESS �YJ a rr <br /> U�� O <br /> LEGAL DESCRIPTION(see tax receipt ( m <br /> __ 4o <br /> r= <br /> DWELLINGIBUILDING GARAGE/ACCESS RY STRUCTURE �I ADDITION ❑ -F <br /> Cr <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ N <br /> STRUCTURE/ADDITION USE: U) 'S <br /> P (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> r <br /> BUILDING CONTRACTOR:-- ' { <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR TO 5 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. M c <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n z <br /> C7 � � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF LL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C O <br /> NORTH(N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO m Q r Z <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 'l_—o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> CA <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE,LOT LIN S. Q <br /> 5. INDICATE IF A WALKOUT BASEMEN IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IIXY <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS j. 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O n ' <br /> m o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ^ <br /> NEEDED. <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDI IONS LISTED BELOW. ° r--) (S 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY IDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 2. ISSUANCE. IS __03. REMOVAL OR <br /> GRADING CUTTING OF TREES P ND VEGET ALTERATIONS AREOALILOWEDTUNLESS SPECF CALLLY ALONG LINE. O <br /> PERMITTED. XAIAI i c PTr AI I nwrn WITHIN THE RFOUIRED WATER O <br /> 4. NO STRUCTURES, INCLUDING RET ININr <br /> SETBACK AREA. This structure t0 be used as private residential <br /> s garage/storage only. Not to be used for human ; m 0 r- v p D o m <br /> N n N a <br /> habitation. m <br /> 6. 0 o <br /> z : <br /> o ID ;, � : m <br /> Y Og � E C <br /> I declare that this application (includin any accompanying schedule) has peen exammea o me ana to me uea� v. my <br /> knowledge and belief it is true, correct i nd complete. I acknowledge that I am responsible for the detail and accuracy of 0 35m <br /> all information contained in this applica ion (including any accompanying schedule)and I further declare that I recognize �n t7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- � o <br /> sue a permit. I further accept all liabilit which may be a result of the County of Burnett relying on this information I am <br /> providing in this app' ation. 1 agree t permit county officials charged with administering county ordinances or other m <br /> do T i ° a <br /> authorized perso have access to th ove described premises at any reasona D <br /> Q <br /> 'I vi i n i <br /> op <br /> SIGN HERE (date) <br /> (sig re owne r ilding contract r) � <br /> AUG 2 <br /> ZONING ADMINISTRATOR (�i ";in in Fn(n <br /> TO NSHIP PERMITS MAY BE REQUIRED 13URNETT COUNTY <br /> PIRE ONE YE <br /> THIS PERMITS ALL EXR FROM DATE OF ISSUAQJR ING <br /> term 1--4 -e �-�ef2� 1�`TF� bnti�s -rre����h 8' �f <br />