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4 <br /> 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 0 <br /> 1 1 �-7 N <br /> OWNERD4 n I� �Y d �1 TELEPHONC7�4 ,.7 y- L <br /> CJII m <br /> HOME ADDRESS �i-7 e'5 /foil <br /> Od h bo I- K. a o � <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> ,Sd/ �a `� s� V( Pia (�,� <br /> LEGAL DESCRIPTION (see tax receipt)�L 1�y l�B�60 7,j—Oe S 2 c <br /> 4-0 1 OFCDn <br /> Q <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ElPRIVY ❑ N <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 9: <br /> S <br /> � <br /> y� tll <br /> STRUCTURE/ADDITION USE: r a 4 c l Ji e' <br /> (Home/C in; Commercial Business, Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: QFf 574f/I AZa h r 6 iv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C c <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 "1 -ZLAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a 2. <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ( t <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 D OF PERMIT <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED AL <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS S <br /> A <br /> PERMITTED. <br /> 4 NOSTRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WIT THE fjEQU RED? t <br /> T <br /> SETBACK / <br /> /r !! J I <br /> 5. ' <br /> 6. BV RNE�cC 3 a <br /> 7. zpN/N lN1"V y- D 02 C <br /> y <br /> 4 0 � (P =1 <br /> o : <br /> -rn : m <br /> 1 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 ? c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m O <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 permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the 44ove described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> Q m <br /> SIGN HERE A/' � <br /> fsfghature of owner or <br /> building contractor) (date) <br /> er <br /> ZONING ADMINISTRATOR ` 1 rn f' IGt71 <br /> wcncnfnv�d+� <br /> N N V1NN(r1N <br /> Ut (TO V1(T 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />