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Burnett County 7410 Co. Rd. K,No. 102,Siren,W154872 Office of Zoning Administrator _ o° o <br /> APPLICATION FOR LAND USE PERMITS �. <br /> ^' r <br /> y O <br /> N <br /> C (� <br /> CD <br /> / i <br /> OWNER �e�� R • RU -�'111J C l\J�/ TELEPHONE 5`!' ,S' ���, � v ,y�le w� <br /> DJ rte- O <br /> MAILING ADDRESS 3 4- �a - qlJ>✓ �y, �u4-h. S-iL, Rkii 811V -5 075 <br /> r � <br /> Nd <br /> 0 <br /> PROPERTY ADDRESS Nd k L i4ke R d <br /> /LEGAL DESCRIPTION(see tax receipt) AC. &L <br /> 7-' 2 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION , O <br /> c 0 <br /> TYPE OF PERMIT(S): v <br /> a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDI�VIISIO(/N El <br /> STRUCTURE/ADDITIONOSE: <br /> r�YA -L VtiG✓� '� N <br /> (Home abin• Commercial Business; Bedroom; Deck;etc.) � <br /> BUILDING CONTRACTOR: 42 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> m <br /> ?t o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m aJ <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS �,� j, --4 -C;— <br /> MUST BE SIGNED AND DATED BY THE OWNER. �`�� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC/yV�444,;;REPQNE WHEN <br /> NEEDED. �' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 4 p o t <br /> CONDITIONS OF PERMIT: so 1 rt <br /> 4 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P REMOVAL CUTTING OIORESTRICTEDR <br /> "'k U ft � tl <br /> 2. <br /> OR <br /> F TREES AND <br /> N IS <br /> 3. O GRADING OR HORELAND ALTERATIONS ONS AREALLOWEDUNLESS SPECIFICALLY <br /> LINEo �'v <br /> PERMITTED. 'Y <br /> V' <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m W1=00maFm <br /> N C m <br /> Z ymo 0(a <br /> 7. O <br /> = U) i <br /> E i A <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 I am responsible for the detail and accuracy of w E i cn <br /> a ^ i <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o 0 <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 I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above des ' d premises at any reasonable time for the purpose of inspection. -n ° o <br /> g m m <br /> SIGN HERE • w���� ` Q <br /> (signature of ow er or building contractor) (date) <br /> 'ONING ADMINISTRATOR vI ' <br /> E»to <br /> EA EA fA fA � N <br /> TOWNSHIP PERMITS MAY BE REQUIRED L�?--3/ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />