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. <br /> Administrator 0 <br /> Zoning 0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of 3 r l <br /> APPLICATION FOR LAND USE PERMITS y s <br /> / 6 3s- x/36 <br /> OWNERP�'`So h TELEPHONE 7 r S o <br /> / O <br /> / M f <br /> MAILINGADDRESS p2D /�U (Q'11 " Ia� � S �/�G� r�✓ �^ <br /> PROPERTYADDRESS <br /> d N <br /> LEGAL DESCRIPTION(see tax receipt) <br /> N o <br /> ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ c <br /> DWELLING/BUILDING n � <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ r2 <br /> 0 <br /> STRUCTURFJADDITIONOSE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: 'z <br /> v <br /> A <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN B%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 , <br /> O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> G <br /> O c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) m o Z <br /> n m z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C `. <br /> NORTH(N). rn v <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> m <br /> Z <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFn I o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. t <br /> AND ALL DISTANCES TO <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF), O <br /> BUILDINGS, ROADS,LAKE, LOT LINES. IN R 1 <br /> 5. INDICATE IFA 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 O <br /> MUST BE SIGNED AND DATED BY THE OWNER. p I <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> o <br /> NEEDED. <br /> sS <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° fI <br /> CONDITIONS OF PERMIT: II <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT . UI <br /> ISSUANCE. <br /> OVAL OR IS fn1 O <br /> 3. NO GRADING OR SHIORELANDNG OF EALTERATIONS ARE ES AND OAILLOWEDTUNLESS SPECIFICALLY LINE. <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. m c m M 0 m Da f m <br /> m x3 nm enc » SDA <br /> 6. o m H o y 3 <br /> Z y y N <br /> o m Tom : m <br /> 7. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my r <br /> : <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of : Ao <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information 1 am <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to rrave access to the abo%w described prifirtises at any reasonable time for the pur ose of i spection. i i m D <br /> //a 6 <br /> n <br /> a : <br /> SIGN HERE <br /> (signature of owpal or building contractor) <br /> FlGtni �1i : : : <br /> ZONING ADMINISTRATOR TM <br /> r ER di fA y1� N <br /> OO N N W W N O <br /> O N O N t l� V• O <br /> T$OWNNSHIP PERMITS MAY BE REQUIRED RE ON YE }� E <br /> THIS��(mL YH } l2�/�Gkt 1-t/�xTT/h ASK y�C'l��cS�f lLiSoh <br />