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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U G) Z <br /> APPLICATION FOR LAND USE PERMITS g 0 0 <br /> Xw <br /> 5T a <br /> .� <br /> c <br /> OWNER I�J2 JTELEPHONE <br /> w <br /> / O <br /> MAILING ADDRESS m <br /> a��s L� Z,16 � �� —i/nv� F <br /> 7 <br /> PROPERTY ADDRESS <br /> S� <br /> LEGAL DESCRIPTION(see tax receipt) AJ w'lc( rV c) 3 a—q-o —/7 <br /> DWELLING/BUILDING ❑x GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ' <br /> 0 <br /> TYPE OFPERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: Ak 8)(�d La. nnnU''' <br /> (Home/C&bin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: � GT er C,a-b4�j <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 31 N O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 m <br /> T n <br /> 't v <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> m � � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C 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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. O <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 tT <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT10 I A�'f3E DQ71 E VJHFSN Q 4-1� <br /> r <br /> NEEDED. r l( „ / F N (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: ,At Y <br /> q d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM8URN H ` `004 <br /> ISSUANCE. / <br /> 2. REMOVAL OR <br /> 3. NO GRADING OR SHRE <br /> ING OF TREES AND VEGETATION IS RESTRICTED ALONG LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY RLINE2O�AI�OUN7�, ' <br /> PERMITTED. I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA <br /> 5. /1 <br /> lit mm m � a o v <br /> 6. " 3 am n <br /> CD <br /> Z m o <br /> 7. R <br /> O 1� ``: M <br /> (n. iv <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my G) U : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w cc <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 o0i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other I d <br /> authorized person to have access to the abovq described premises at any reasonable time for the purpose of inspection. m U) <br /> T 0 : <br /> CD <br /> SIGN HERE CD <br /> (signature of ow er or building contract (date) <br /> : <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAYBE REQUIRED <br /> '� THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />