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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -UG) Z <br /> APPLICATION FOR LAND USE PERMITS 3. �� 1 <br /> N <br /> 41 <br /> C <br /> N <br /> OWNER\ p BAR AXA S TELEPHONE 7/ r/_ / <br /> MAILINGADDRESSCDLI )Ty - p00 ? 1 S�IBoe 0 <br /> ) <br /> 0 <br /> O <br /> PROPERTYADDRESSSAIA <br /> O <br /> LEGAL DESCRIPTION(see tax receipt) ?C �~ fD y93 ��3 S2y T*/R I V W S- 1 <br /> , I <br /> 2-'ib�!N-2�128 UT-q C a14 V I P 217 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ N 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ C: <br /> STRUCTURE/ADDITION USE: nra T n V% 41 �' 1C n ra q C>r Ciltl�Q �1V <br /> (Home/Cabin; Commercial iness;Bedroom; k;etc.) <br /> BUILDING CONTRACTOR: <br /> -o <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO . <br /> 0 c O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p CD <br /> T 0. <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n ` A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m o <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. <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. * C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2. <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIOI-M'41"f`DONE WHEN o <br /> NEEDED. 2 \ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �a z <br /> CONDITIONS OF PERMIT: + C p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER ITi/IL I <br /> ISSUANCE. ( ., <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY y^ {n <br /> PERMITTED. �1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. l I <br /> 5. NO <br /> m r 0 ( a 0 M <br /> _V y) d <br /> 0 3 a 0 x° A <br /> 'O N C <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — =' <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of /p �� w cc i» C— <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 iw <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above describe premises at n reasonable time for the purpose of inspection. m <br /> -n p <br /> G ^ N N <br /> SIGN HERE {— A 3— [1469 <br /> ` a : <br /> gnatu of ow r it m ontractor) 21511 (date) <br /> ZONING ADMINISTRATOR <br /> fA fA fA <br /> N fa 0 N <br /> t�N V I N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />