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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> n O <br /> 7iS— g(a6- 474.0 .� <br /> OWNER <br /> ,JP 0, Va.�1G�e,v�t7�Oe.G1 TELEPHONECiS �4OI-9Z(J� � o 4 <br /> m <br /> 1 {_ m <br /> MAILING ADDRESS V11Q ��� ��� C� / n J, c�� C n10-o{ waa A k) iy (/(�S�j�� v O <br /> PROPERTY ADDRESS �1!; �( 6O C C La,4 Rd t'V t bck( � 1 F6 p-1� � � � <br /> LEGAL DESCRIPTION(see tax receipt) /—/ 2- -�.5o/f &)f 30 w 6)V 14 3 �c Zi TIU f 39 kqz 110 ~ N <br /> DWELLING/BUILDING ElGARAGElACCESSORY STRUCTURE ❑ ADDITIONZq <br /> TYPE OF PERMIT(S): t01/RYIC�Pi-��Df <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVIS`ON ❑ n <br /> N <br /> STRUCTURE/ADDITIONOSE: ret11 (?O Y G1 1 on 1 C a Lin <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) 0J1 <br /> BUILDING CONTRACTOR: �AYV�II �ICIC�] '��✓f? d' <br /> 1 <br /> v <br /> D O <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO f (� <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <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 <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 /> INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N� pU <br /> A8 IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS �� t <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY QQQNNNE WHEN a 00 <br /> NEEDED. 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> y I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ANY 7-- <br /> ISSUANCE. -ISSUANCE. <br /> VEGETATION2. REMOVAL OR CUTTING OF TREES AND IS RESTRICTED ALONG <br /> 3. NO GRADING OR SHO ELAND ALTERATIONS AREAOR <br /> LOWED UNLESS SPECIFICALLY CAYLINE. BURNET7 <br /> COUN <br /> PERMITTED. ZONING <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> � l.i/ (/'tom ,,- ,, •,,l �'"LL.. �/" r'—"` CD W 0 0 > 0 <br /> CD rn <br /> 6. <br /> m C N ,0' O � 3 <br /> � Z w O <br /> . : 1 <br /> T, G M <br /> M <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my = ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m e, <br /> PP (including Yaccompanying ) g �' <br /> all information contained in this application Includin an schedule and I further declare that 1 recognize C o m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 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 above described premises at any reasonable time for the purpose of inspection. T `D s <br /> o : <br /> m m <br /> SIGN HERE" <br /> (signs o caner r buildin 'Zr)//� (date) <br /> ZONING ADMINISTRATOR <br /> fAEA EA EA� N <br /> N V N N O <br /> U O U� (TOOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />