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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator -U G) c <br /> APPLICATION FOR LAND USE PERMITS <br /> N <br /> Jt <br /> T / <br /> OWNER s7/eU �� / Vit Q f �l SOrI TELEPHONE qn 6 o� o ' A., <br /> MAILING ADDRESS 6`17 6 Q6, /jb o <br /> r m <br /> 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) S, a a T 410 R. /6 a 5 JE tie /L/h/ , <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION to O' <br /> TYPE OFPERMIT(S): 47 c (� <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> J <br /> STRUCTURE/ADDITION USE: Q ` 0 J <br /> (Home/Cabin;Commercial Business; Bedroom/;;Deck; etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> T a <br /> r o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(N8)AND INDICATE <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 7 <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. ) � O <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N .w <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS —,Do O <br /> MUST BE SIGNED AND DATED BY THE OWNER. 5 a <br /> m <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI EN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: it <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERRMrfrN�� <br /> ISSUANCE.2. REMOVAL OR TREES AND ALONG <br /> ?? ] <br /> 3. NO GRADING OR SHIOREOLAND ALTERATIONS AREI ALILOWEDTRICTED UNLESS SPECIFICALLY LINE�Gh//NG �I,/" r <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> fm <br /> 6' 3am �c • � � <br /> m <br /> '0N C y m 7 <br /> 7. Z <br /> M <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m O <br /> PP ( 9 Y ) Y y C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of o <br /> PP (including Yaccompanying ) g <br /> all information contained in this application includin an schedule and I further declare that I recognize m C m <br /> : v <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. 1 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 m E <br /> authorized person to have accesp to the above described premises at any reasonable time for the purpose of inspection. m U <br /> Lf <br /> m o : <br /> SIGN HERE <br /> (sign ur of owner or b tiding contractor) (date) ` o. <br /> ZONING ADMINISTRATOR �i IJ1 <br /> 69 69• N <br /> .L T j G OA O O <br /> ((CV((J _ -(J iCi-/ TOWNSHIP PERMITS MAY BE REQUIRED <br /> ' THIS P RMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />