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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N <br /> CD <br /> OWNER ��,t ��l �!'!!' `r TELEPHONE a <br /> MAILINGADDRESS al +v qth �;(p �L � 0 <br /> 0 r � <br /> PROPERTY ADDRESS o <br /> LEGAL DESCRIPTION(see tax receipt) I`Y ( 51y 41p a 00 <br /> ISI � � C <br /> DWELLING/BUILDING 1:1V <br /> GARAGE/ACCESSORY STRUCTURE ❑ ADDITION I (n 0 <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING 11 CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> < V/ <br /> STRUCTURE/ADDITION USE: ansift3 ,C'ea"pn icyrich 0 <br /> (H m /Cabin; Commercial Bu mess; Bedroom; Deck; etc.) co U <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y�X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 5 m O� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn Z <br /> NORTH(N). n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO mC C1� E <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF l 0 <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. �f N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 5 ^ \ <br /> MUST BE SIGNED AND DATED BY THE OWNER. ^ o �}J <br /> v � t <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 6 <br /> CONDITIONS OF PERMIT: ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE <br /> ISSUANCE. �� }% I�\ () ) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SH <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICAL O <br /> PERMITTED. I I O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE R IRED WJANR s 2005 / <br /> SETBACK AREA. L V <br /> 5. <br /> BURNETt COUNTY � W v > o a � m <br /> s' ZONING a a a <br /> 0CDC: 3 <br /> 7. Z C y N O � <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — fn: 0 <br /> PP ( 9 Y ) Y y <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of v <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ° to <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 m o <br /> providing in this application. I agree to permit county officials charged withadmini rin ounty ordinances or other m <br /> authorized person to have access to thee��above described premises at any reasona do m <br /> �J Jp Q T _a <br /> SIGN HERE Y CY /4• C 1 I D <br /> iCD <br /> a <br /> � ii to ' a <br /> (signature ofote <br /> w er o uilding contractor) ( atetf o <br /> ZONING ADMINISTRATOR I OCT 2 F � <br /> �DweuirJ�p ao85 jBURNETT COUNTY Q O N <br /> �U W�W� N O <br /> oovo <br /> TOWNSHIP PERMITS MAY BE REQUIRED 7C((��� <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE O�LSSUANPE <br /> NG � <br />