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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -U o0 <br /> APPLICATION FOR LAND USE PERMITS <br /> y O Q <br /> � � ) / 1 / <br /> OWNER J �� l� �( TELEPHONE 6/p0 �(�3 -1722 <br /> MAILINGADDRESS BQ(,( �J^ �jT prGll^Je /'1 S53y <br /> r <br /> PROPERTYADDRES csly a p t/ <br /> ? / <br /> LEGAL DESCRIPTION(see tax receipt)PC/-f 6jy 1p� —(c G �y / yU /V/ /ep!y 1/�+, y <br /> m <br /> DWELLING/BUILDINCr9 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ � m � <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ C/kiMPING UNIT ❑ SUBDIVISION ❑ R, <br /> / T.f� o <br /> STRUCTUREIADDITIONUST: 0 <br /> (Home/Cabin;/Commercial Business;Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: ��'tfi• X/h �I��� L��/1 fir <br /> Q �. <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 4 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o �5' <br /> A2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE �y <br /> NORTH(N). y "I 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. <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. C.. <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 ) 0_ <br /> MUST BE SIGNED AND DATED BY THE OWNER. (1 'c f r <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 1J ho-j- �� o <br /> CONDITIONS OF PERMIT: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS O PERM(�Us 7 yam' <br /> ISSUANCE. -1 [ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SH <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICA zz((T��T��''^^(�'`��Q,UNTv i 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRI= N4r42 ' r �J <br /> SETBACK AREA. <br /> 5. �/7' �)IL `-C� l.� /h -(,'�.. m w m 0S)a O V <br /> 6. $ 3amOWi M <br /> Z N m <br /> 7. o M <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of n c{ N y <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o my <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 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 /> m : W: <br /> authorized person to h e access to the above de cr'bed premises at any reasonable time for the pur ose of inspection. o : <br /> M m <br /> SIGN HERE C <br /> o \ : a : <br /> (s of owner or ding actor) (date) <br /> ZONING ADMINISTRATOR <br /> " ffA fA EA EA�N <br /> N� 0 N N O O(TOUI (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />