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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o o <br /> AP LICATION FOR LAND USE PERMITS 3. <br /> r <br /> �J v <br /> OWNER /J�}� S�JI�-rZJ wA TELEPHONE //� /��I�tO <br /> m <br /> � CDO <br /> MAILINGADDRESS 4 W4b <br /> . S <br /> r- <br /> '0 m <br /> PROPERTYADDRESS fjp��;t 4K, ) l <br /> LEGAL DESCRIPTION(see tax receipt) I t (� � L [ � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ pQ� to 0 A <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ .A RCAMPING UNIT 1:1SSUBX-DIVI` S <br /> SI/ON ❑ <br /> STRUCTUREIADDITION USE: �O I e_ �- -t /�P J Y' 0 (� V <br /> (Home/Cabin;Commercial Business; Bedroom; Deck,etc.) to � <br /> d <br /> BUILDING CONTRACTOR: D W n/e fi�— d <br /> v <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 .� <br /> ;a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a l <br /> MZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <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 /> \ Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z�' P <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 D <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. IF M <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. p <br /> CONDITIONS OF PERMIT: //�� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P MIT API? 2 QQ? <br /> ISSUANCE. Q <br /> 2. REMOVAL OR <br /> NG <br /> OF TREES AND VEGETATION IS RESTRICTED ALONG SR <br /> 3. NO GRADING OR HI ELAND A TERATIONS ARE ALLOWED UNLESS SPEC F CA L AWNE-rT C O��rY r�{ <br /> PERMITTED. ZONING VVV <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. � � ,y m m ori o a DO <br /> 6. /� A p Z� ^r� G� 07— 23 n a <br /> IDM <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 9 , c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 0 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 a cept all liability which m be a result of the County of Burnett relying on this information I am m <br /> providing ' this applic tion. I agree permit unty officials charged with administering county ordinances or other <br /> authorized person e access to e above escribed pr9mises at any reasonable time for the purpose of inspection. m : s <br /> m o : <br /> CD m <br /> SIGIN H _ y_0 �—Q� <br /> a : <br /> (signature o owner QObullding contr ctor) (date) <br /> t <br /> ZONING ADMINISTRATOR <br /> • vi v. <br /> EA EA EA to 0 N <br /> � N O O <br /> � O � N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />