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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O <br /> M F�� <br /> C V <br /> OWNER TELEPHONE bS'I - 4137-7Sw/ o <br /> ',// / <br /> MAILINGADDRESS /C)/ �, Mlle 5'Y. t/C/`odhiN No <br /> m <br /> 0 <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) % / SCL to <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION El Q-\> rn 0° <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING 1:1 CAMPING UNIT 1:1 SUBDIVISION ❑ a <br /> STRUCTUREIADDITION USE: C B 6rt I/ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn R <br /> � {/ m <br /> BUILDING CONTRACTOR: se-Ac- ru <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n rl <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> In <br /> mZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(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 <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ) N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI 51 o <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J(/N o C� ^� <br /> CONDITIONS OF PERMIT: V <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF Q-"'YE CUTTINGCo <br /> 2. REMOVAL OR T / O <br /> 3. NO GRADING OR HO ELAND A TERATIONS ARE ALLOWEDUNLESS SPECIFICALLY <br /> U' <br /> Y LINUN, <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK. <br /> 6. 3COL mOx <br /> -o <br /> MC: y `0o � 3 <br /> 7. Z rn10 x(01 <br /> P "' m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n <n <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m O mm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- fD <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 w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 0 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ° o <br /> m M <br /> SIGN HERE 0 — 07-0 <br /> (sign re of or bulldi ntract (date) <br /> a <br /> y� <br /> ZONING ADMINISTRATOR t-[�/ / C <br /> fA <br /> Ln Nt90 N <br /> (�N U N O O <br /> NO (n cn00 <br /> TOW SHIP PERMITS MAY BE REQUIRED <br /> U <br />