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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> N <br /> C <br /> OWNER u► s TELEPHONE / , 0 -�3Uy o <br /> L <br /> MAILINGADDRESS icy y� Lt} �Lr•JCi � Al �,�Q EIry)y v C� <br /> PROPERTYADDRESS ) "7 - � � " S�� �^ <br /> LL�fJ� ' �ll (D Ftl1 t�7 5 i <br /> LEGAL DESCRIPTION(see tax receipt) S I ltol � <br /> rt C m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ElL (n <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ !�'�` a <br /> STRUCTURE/ADDITIONOSE: � <br /> (Home/Ca in; Comm6rcial Business;Bedroom; Deck;etc.) ro <br /> m <br /> 0 <br /> BUILDING CONTRACTOR: u <br /> 1 <br /> U <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> :0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (n c <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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. <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. f <br /> v o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC/�l�l � o <br /> NEEDED. // 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> z � <br /> CONDITIONS OF PERMIT: /�u� } �,� p Q <br /> J 002 (1 _ � <br /> t <br /> ISSUANCE. <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER9FJRNEn CO / Y(J l <br /> 3. NO GRADING OR SH2. REMOVAL OR IO ELAND ALTERATIONS ARE ALLOWED NG OF TREES AND VEGETATION IS TUNLESS SPECIFICALLY RICTED ALONG RLIN . ZON'NG <br /> t <br /> PERMITTED. (, <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER �•J <br /> SETBACK AREA. <br /> 5. <br /> mm rrDi 0 > 0- 0 <br /> m <br /> 6. �' 3 am Fam M <br /> m C H o 3 <br /> 7. Z in m `o <br /> o-n � <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ,' A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D o m <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 d <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or otherIt <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. (D o <br /> SIGN HERE f //(/ !�1z3/0 <br /> g urMowr flding contractor) (date) <br /> a <br /> ZONING ADMINISTRATO V� <br /> e»ei <br /> rte.. fA fA EA EA� N <br /> \t/J(/ N (li NNOO <br /> (TON (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> Way <br /> /S/Q�ap <br /> `� [ �� <br />