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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 /> r <br /> N 5 <br /> N <br /> C <br /> OWNER .c-_j� 41"eS TELEPHONE <br /> MAILING ADDRESS <br /> fn 91Az ;c-4 <br /> I , r m <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ m 0 <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ /CA��PING UNIT ❑ SUBDIV OW I o <br /> STRUCTURE/ADDITION USE: (_-�fhl 2 ( , -- <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: l/v/ 5 lr ��C> iLC <br /> CD <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 /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> TZ \ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). fn O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> a <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. 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. !V No <br /> W� <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. I o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITEVERT :170 MAY BE DONE WHEN y— c " 1 <br /> NEEDED. Z <br /> l � i~ <br /> �! <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. O r <br /> CONDITIONS OF PERMIT: 'I/, C � <br /> LA <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DA PERdVN 2 O I Q y In <br /> ISSUANCE. J' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG / Is (� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY T <br /> COUN , <br /> PERMITTED. ZONING COUNTY <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. I I <br /> 5. w <br /> M mCD <br /> og On0 -0 <br /> m <br /> 6. 8 3nmx� m � <br /> 7. Z rnm0 O� 1 <br /> o �-j�2m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my It 1: <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 : iA <br /> PP (including Yaccompanying ) g a 0 M <br /> all information contained in this application mcludin an schedule and I further declare that I recognize C O : G <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. I agree to permcounty officials charged with administering county ordinances or other o <br /> authorized person t e ac ss to the abov cribed premises at any reasonable time for the purpose of inspection. m = <br /> T CD O : <br /> SIGN HERE <br /> lore l9 z� <br /> (signal of ow 'Iding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> VfA fA fA EA�N <br /> N N N N O O <br /> CT O CT (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />