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Burnett County 7410 Co. Rd.K, No. 102,Siren, WI 54872 <br /> APPLICATION FOR LAND USE PERMITS Office Of Zoning Administrator <br /> 0 <br /> OVIMERq ��. Sa <br /> V _ r <br /> � N 4 <br /> K.. VA AA.�-r._QQ <br /> MAILING ADDRESS a��j l e) j p <br /> bJ I�w /may IrA�nL� r�( Q ,1 li,f L 4813 " O <br /> PROPERTYADDRESS �j ry <br /> LEGAL DESCRIPTION(see tax receipt) N <br /> wf SW ter � c q D,Q a-3']-1�4-d�-o ' <br /> TYPE OFPERMIT(S): DWELLING/BUILDING _ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION O p N <br /> .D <br /> FILLING/GRADING ❑ CAMPING UNITE] n I go o <br /> STRUCTURE/ADDITION USE: — SUBDIVISION ❑ fV <br /> f` r <br /> (Horn abin; Commercial Bus ess;Be om;Deck;etc.) ° <br /> BUILDING CONTRACTOR: <br /> - � V <br /> d <br /> st <br /> I PLOT PLAN MUST N PROVIDED ET R LEAST AN 8'/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) T <br /> O <br /> 1• ALL REQUIRED DIMENSIONS OR 0 m <br /> c <br /> 2• SHOW THE LOCATION AND SIZE OF ALL EXISTING NG BUILD NGSSHOWN REB)AND ALL N O a <br /> NORTH(N). DRAWN TO SCALE. ?I <br /> NEW BUILDINGS(NB)AND INDICATE m o ? , <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF C 3 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. y <br /> 4• SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO B <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Cho <br /> 6. MUST BE SIGNED AND DATED MSEPARATE PLANS ARE SUBMTTED BY AN ARCHITECT,ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS <br /> MTHE OWNER. <br /> 0 <br /> I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF <br /> o 0 <br /> NEEDED. F ' <br /> YN <br /> S <br /> C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> ONDITIONS OF PERMIT: /� X/ <br /> t DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 p ��o 0 1'r <br /> ISSUANCE. DAYS OF P /A/v�.� ��� <br /> Z• REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINL�&/ /(',Ou v <br /> 3• NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY N(; <br /> PERMITTED. I <br /> 4. SE STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE <br /> SETBACK ARE <br /> 5• REQUIRED WATER <br /> 6. <br /> 7. <br /> .0 r- DO <br /> $ 3amo6aF m <br /> x^ � M <br /> I declare that this application (including any accom an in C y w S 3 <br /> knowledge and belief it Is true,correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy of o m o 7 <br /> all information contained in this application(including any acc mpanyln as been examined by me and to the best of my T m <br /> that this information I am providing will be relied upon b t I , A <br /> g schedule)and I further declare that I recognize "�/ CL c^ ` N : m <br /> sue a permit. I further accept all liability which may y the County of Burnett Wisconsin in determining whether to is. r sa <br /> Providing in this application. I agree to permit county officials charged with administering coup G o <br /> authorized person to have access to the above described premises result of tat any reasonable time for the county <br /> ordinanceshe County of Burnett relying on this <br /> r I other G) ' <br /> ty ordinances a other m' <br /> SIGN HERE P of inspection. m cn <br /> 0 <br /> (signature of owner or uildi contractor) g �� <br /> d <br /> ZONING ADMINISTRATOR <br /> Idiom) <br /> CL69 69: <br /> TOWNSHIP PE MITS MAY BE REQUIRED 109`S`69 — <br />