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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'U O Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> bi <br /> D <br /> OWNER ()n,.L a\Q 5 TELEPHONE457- <br /> �' O �� v t� <br /> � <br /> MAILING ADDRESS -79010 B10CD <br /> ��C�Rr. O <br /> PROPERTYADDRESS �9n Q <br /> LEGAL DESCRIPTION(see tax receipt) <br /> LOQ 5S "a Riyni- 1-4b lQ k4oa6-9135-0b-is o co <br /> CD <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ?A �ADDITION ❑ � ii' <br /> � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITIONUSE: De o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> m <br /> BUILDING CONTRACTOR: MkS� <br /> m <br /> CD <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 0 m <br /> O m L., <br /> -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> CR <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 0 <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. O <br /> 5. 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. 5 -I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI DONE WHEN <br /> � � o <br /> '�-6k <br /> NEEDED. J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: p d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P �RMIT Opf ?(103 <br /> ISSUANCE. �ff//����� pa <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHO RELll4t"vF�Co � p <br /> 3 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECED. IFICALLY zpNING UNTy <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m d 0 Mnf m <br /> $ 3 am O� nm <br /> 7. NC -j N O_ _ <br /> Z N 0 O 0 <br /> 9 T'� ."0 <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 n vi C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Q.m � <br /> o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C G <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 oO <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 described premises at any reasonable time for the purpose of inspection. <br /> -n <br /> O <br /> SIGN HERE m m <br /> ` �t�rxlo3 <br /> (sl atu a of o ,royrbuilding contractor) -� (date) <br /> ZONING ADMINISTRATOR '/!L <br /> 7n �y$/V <br /> N U t N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED N <br />