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CA mv7w <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U 0 z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r. r <br /> VT O <br /> N <br /> C l <br /> OWNERL,/1 TELEPHONE <br /> o <br /> HOME ADDRESS (? x �" W z�J�R! I J, 3 r� A <br /> PA CD <br /> l� <br /> (DJ, r <br /> EMERGENCY/FIRE NUMBER ROAD NAME )�y 1C CO3y//F 0 <br /> L 3S I'll J Q/ CVol/ '3 3 01-1 <br /> LEGAL DESCRIPTION(see tax receipt) w S W S X1`07 T-..%Aj 0—iu lov. �ll fur_I <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE. ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): C <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ UBDIVISION ❑ <br /> a <br /> STRUCTURE/ADDITION USE: M(f fit_ U N2 r...l ��'J`Gl.�� S' <br /> (7ZL,bin; Commercial Business; Bedr om; Deck; etc.) N <br /> BUILDING CONTRACTOR: r��'YZ IYI S rye C+ <br /> iu <br /> v <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. m <br /> �l N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> m o <br /> 'A z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 0 m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF l] <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IM��J N <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. J 'i <br /> lS o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 11Fn o <br /> NEEDED. <br /> 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: o I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITQ <br /> ISSUANCE. ( <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG S \ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFIC Mi" <br /> PERMITTED. ��j <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN TH QUIRED V �+t�U <br /> SETBACK AREA. V <br /> 5. �/� <br /> 6. y �1 iQAIV� 2 p l�Q� / 0 M. a) 0 m a* M <br /> m <br /> Vrl'V � f m <br /> E . < 3 am F � m � <br /> (D C <br /> m y N O ]' <br /> N O <br /> 7. ZO COV/AfeN o „ . m <br /> — � : : <br /> I declare that this application (including any accompanying schedule) has been examined by me anC) <br /> the best of my G) c <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize '� ` ' m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue apermit. I further accept all which may be a result of the County of Burnett relying on this information I am <br /> providing in this application. I ree tormit county officials charged with administering county ordinances or other <br /> authorized pe o have acces to the ab ve described premises at any reasonable time for the purpose of inspection. fD <br /> o <br /> SIGN HERE <br /> (signature uilding contract ) (date) (� <br /> ZONING ADMINISTR R <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> k8'- <br />