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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 p <br /> N <br /> �J <br /> d W <br /> OWNER O 3 O TELEPHONE 6 _ _ Ot <br /> d <br /> m <br /> MAILING ADDRESS -7336 ' 1C O <br /> r m <br /> 0 <br /> PROPERTYADDRESS /r 12 0 <br /> \ ' Yl <br /> LEGAL DESCRIPTION(see tax receipt) (. a`c AA Tq09k 1QV <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 5? ADDITION ❑ m 0 <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑ C MPING UNIT ❑ SUBDIVISION ❑ <br /> ErL <br /> S. <br /> STRUCTURE/ADDITION USE: <br /> 3 <br /> ( o / abin;Commercial Business; Bedroom; Deck;etc.) rn <br /> f� <br /> BUILDING CONTRACTOR: <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. m Q <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <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). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m Q \ 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)N EASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFZ <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 t <br /> BUILDINGS, ROADS, LAKE, LOT LINES. S 2 <br /> S. 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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION*a WHEN O <br /> NEEDED. <br /> V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: !j SFP <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER <br /> ISSUANCE. RIF 2 �b <br /> 2. REMOVAL OR 3. NO GRADING OR HING OF O ELAND ALS AND TERATIONS S ARE ALILOWED UNLESS SPECIFICALLY IS RESTRICTED ALONG ORLINE. 2O� Co <br /> PERMITTED. NG rUj <br /> 4. NO STRUCTURES, INCLUDING RETAINING ALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> AREA. ylw <br /> 'J� This structure to be used as private residential W 0 r >o a o -0 <br /> garage/storageonly. Not to be used for human g 3 a m `s n <br /> 6. habitation. z R " _ s- <br /> o 3 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — p <br /> knowledge and belief it is true,correct and co L7 c C <br /> g plete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(in(luding any accompanying schedule)and I further declare that I recognize m o : my <br /> that this information I am providing will be relic d 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. 1 agree to permil county officials charged with administering county ordinances or other °1 <br /> authorized persoto have access to the above Jescribed premises at any reasonable time for the purpose of inspection. fDCD <br /> c <br /> CD m <br /> SIGN HERE 911EQ� d' n <br /> (signator ner r building contract (date) <br /> ZONING ADMINISTRATOR (� <br /> / vi r69 <br /> ) <br /> 40440// AlNO (T Gn00 <br /> N (TNNOO <br /> TOWNSHI PERMITS MAY BE REQUIRED •4397 <br />