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w <br /> Burnett County 7410 Co.Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator 3 o z <br /> APPLICATION FOR LAND USE PERMITS <br /> N <br /> N <br /> C <br /> N <br /> a <br /> OWNER 45E <br /> _ "3 0 <br /> MAILING ADDRESS �i0 014CB, S ��� MNUj <br /> _ o <br /> N» <br /> PROPERTY ADDRESS PJ 75 10,11e, ST <br /> Ncn <br /> PSN <br /> LEGAL DESCRIPTION(see tax receipt) st�� ��7- 04 <br /> r o <br /> DWELLING/BUILDING D4 GARAGE/ACCESSORY STRUCTURE El ADDITION ❑ ( O c <br /> o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ j <br /> STRUCTUREIADDITIONQSE: �-F <br /> (Home/Cabin;Commercial Business,Bedroom,Deck,etc.) <br /> BUILDING CONTRACTOR: otilE �J W tsl E-P3 <br /> v { <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 N U <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. M vN - <br /> O m <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) n alD <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> Z! v_ Op <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE y O o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO In 'a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(OF),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. ?ENGINEER I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, BUILDER,CONTRACTOR, ETC.,THE PLANS o <br /> o <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> Z n I <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 0 <br /> ISSUANCE. 1 <br /> CUTTING2. REMOVAL OR RESTRICTED <br /> 3. NO GRADING OR HORELAND A TERATIONS ARE ALLOWEDUNLESS S EC F CA LLY LINE. <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. i/ (it/ 6t <br /> 3 nm xafD A <br /> 6. � Q m Cm m 5� <br /> /-5-5 P - T'2 ' m <br /> 7. =c' A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o : A <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of 0 M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <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 <br /> permit. I further accept all liability which may be a result the County of Burnett relying on this Information I am <br /> lication. I agree to permit county officials � ng county ordinances or other <br /> providing In this app 9 m <br /> for the purpose of inspection. T c <br /> authorized person to have access to the above described prem i ` — CD <br /> : m <br /> M <br /> SIGN HERE (date) <br /> (signature of ow er or b Ing contractor) ` <br /> ZONING ADMINISTRATOR OVN <br /> N (T N N O O <br /> (TON T O O <br /> TOWNSHIP PERMITS MAY 1394411MIED <br />