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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> - r <br /> N � <br /> OWNER TELEPHONE 76 3 ro <br /> m <br /> MAILING ADDRESS /4/7 Zp ?j/ N p G 9;e2ey-V7i,< l o'V 53rV V Z <br /> r m <br /> _ o <br /> PROPERTYADDRESS 9ZZ QFx A/L. - 2 0Z�4/ I <br /> LEGAL DESCRIPTION(see tax receipt) S 1f- <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION C/ 0 <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ <br /> a <br /> STRUCTUREIADDITION USE: C,Al D,41—G A 0/v C 19 I A/ � o <br /> Home/Cabin; Commercial Business;Bedroom;Deck;etc.) y <br /> m <br /> _ <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LE ST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED T - <br /> ;a y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AE RIAL OR TOP VIEW) O m <br /> T a. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTAN ES 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 <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 C� <br /> BUILDINGS, ROADS, LAKE,LOT LINES. �3 <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o ' <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS UST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <br /> � w v ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ' <br /> CONDITIONS OF PERMIT: 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF,PERMIT Lh <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONCl3�0RELINEv`\� V (� <br /> 3 NOGRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIICALLYPERMIgG ` <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN TH EQUIW AT�� v <br /> SETBACK AREA. <br /> y S <br /> 5. o O� �/\�cS�y► / ;a Cly DOD0 V <br /> 6. m s o m a <br /> �' 3nm0 cm 0 D � <br /> 7. '�`.. .� Z N m O O <br /> O n <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my u - r^ A <br /> a and belief it is true,correct and co <br /> � c C <br /> knowledge plate. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C a N mo <br /> that this information I am providing will be rel ed upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. 1 further accept all liability whit i 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 o <br /> authorized person to have access/to the abovi described premises at any reasonable time for thepurposeof inspection. m o <br /> CD <br /> SIGN HERE 044 {^� -�✓ HOZ d' o <br /> (signature of owne or bud con ct (date) \; <br /> ZONING ADMINISTRATOR69 <br /> f� <br /> OI O NC)CNU1 Ut O t DO <br /> ��� NvA O <br /> TOWNS IP PERMITS MAY BE REQUIRED / <br />