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Burnett bounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _ o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> ° <br /> M a <br /> OWNER 1��k� Q m ZT v� 1 Sd r\ TELEPHONE N v s t — '--I 39 -coa9 7 <br /> MAILING ADDRESS 1 1 a 1 Le.cu��r Cc> M rQ SSpSR <br /> r � <br /> 0 <br /> PROPERTYADDRESSl>JZrj���g3 <br /> / 1 <br /> LEGAL DESCRIPTION(see tax receipt) Cj/ LI(��� t♦ 5 Cl) <br /> m <br /> i <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 1 v> 0 <br /> TYPE OF PERMIT(S): a = <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> CLm <br /> � a <br /> N <br /> c <br /> STRUCTURE/ADDITIONUSE: 3�i x S / 1 6)tc— ?"�— <br /> (Home/Cabin; Commercial Business; Bed ;Deck;etc.) (n <br /> m <br /> �� � <br /> BUILDING CONTRACTOR: C\e Z C'n �� ��' �v lon, m <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> X <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 O <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Y <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. dC1 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. o P <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICA HEN "- g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: MAY 1 L _ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PIN <br /> ISSUANCE. e <br /> Tr C® •� <br /> 3. NO GRADING OR SH2. REMOVAL ORI NG ELAND ALTERATIONS ARE ALLOWED UNLESS SPEC FICALOF TREES AND VEGETATION IS RESTRICTED ALONGRY LINE zpNING U/VTM <br /> PERMITTED. �+- <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (thy <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential ;o 0 r D O D o v <br /> 6. garage/storage only. Not to be used for human CD w0 <br /> d g (D a. f m <br /> N 3 a N Ox .ZI <br /> habitation. a m c N ^ <br /> 7. Z wmo <br /> o 42 <br /> -n <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G> c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of d n in: <br /> 0. cn <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �} m O mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 1 <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 O m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 01 ' <br /> authorized person to have access to the abqye d scribed premises at any reasonable time for the purpose of inspection. `D <br /> � . 5 CD <br /> SIGN HEftF�/ <br /> (signatur ner�orMbuilding contractor) (date) ? <br /> ZONING ADMINISTRATOR <br /> Q� <br /> J I(Yl 7 ICin 11 \: <br /> (� fAEA f a fA N <br /> NCT N NOO <br /> (/ G-( (TO (T ()i00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED I a Y9 <br /> 4q-3- ✓ <br />