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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator 1 m o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> -�1���- <br /> n <br /> OWNER g�v, b 'tc l�J r2G �La \ce TELEPHONE 5'S�— �ja�4 - �ouStl <br /> �, [( Q & 60""L'i O <br /> MAILINGADDRESS --10,06-klo(ol�l t� --10,06-k & 6 <br /> k 0"t"w ' <br /> p (` 1 � ) 0 <br /> PROPERTY ADDRESS (03 1� <V%d u p �Ctb 1p 1A9(�S+E�- uv� <br /> ^ n //1 CD (0- / ` P <br /> LEGAL DESCRIPTION(see tax receipt)G � C/-J `sh, r3 / l - l/0CD <br /> O� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION (� g (� <br /> c <br /> TYPE OF PERMIT(S): n o <br /> FILLING/GRADIEl CAMPING T ❑_ SUBDIVISION /I..,; <br /> STRUCTURE/ADDITION USE: V tj'� XX rQ ' <br /> J" <br /> (Home/Cabin;Comm rcial Business; Bedroom; Deck;etc.) <br /> N 1 <br /> BUILDING CONTRACTOR: <br /> M <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 0 3_. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) O a <br /> In o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 9 M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :" <br /> NORTH(N). m O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGG <br /> S)TO ALL LOT LINES,(B)BUILDINGS)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 L <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. tx N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2. o w <br /> MUST BE SIGNED AND DATED BY THE OWNER. I <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICI�TIpN qaE l) NE WHEN Z <br /> NEEDED. I J I\\l I �(lrJ/y/� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. i� 1 ! ° C <br /> CONDITIONS OF PERMIT: Noll 1 Q Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 2003 I ` <br /> 3. O GRADING OR SH2. REMOVAL OR IORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY NG OF TREES AND VEGETATION IS RESTRICTED ALONG LINE ZONING <br /> E N N O�NTY J <br /> PERMITTED. I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> CD 3 a m x D <br /> 6. N y n y j 2 <br /> Z y O ; <br /> 7. o T� i m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of—my v ) G8 2 i : C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of rrte+''•.s a N <br /> W <br /> g schedule)and I further declare that I recognize <br /> all information contained in this application(including any accompanyinm m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i G) <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 <br /> providing in this app ation. 1 gree to permit county officials charged with administering county ordinances or other <br /> authorized person t ave s to the above described premises at any reasonable time for the purpose of inspection. -n o <br /> CD <br /> n3 `� a <br /> SIGN HERE G <br /> (s gnat owner or building ntractor) (date) <br /> t G <br /> ZONING ADMINISTRATOR I R <br /> �� N (TNN 00 <br /> (n 0(nCn 00 <br /> -nw <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ��ps <br /> 0'2 THIS PE�MIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE tP <br />