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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. =- <br /> r <br /> UT o <br /> CDc <br /> OWNER � �" TELEPHONE n <br /> avr� Ty r Ci A �" s 60 — 773 9 63 a <br /> W <br /> HOME ADDRESS Ad5W in4 f 4 l &641e- MV* bM v O <br /> r <br /> EMERGENCY/FIRE NUMBER gC6� ROAD NAME <br /> P <br /> LEGAL DESCRIPTION (see tax receipt)�.L. 13y -G1 �r j,,,, -t �,J_� Jg�lW",,eakta���/�� , M <br /> 11 �Ifb T v'cL17��� 1. `° <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY [9 41J•�C, to ° <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ ° <br /> STRUCTURE/ADDITION USE: � <br /> (Home/Cabin; C ercial Business; Bedroom; De ,etc.) <br /> m <br /> BUILDING CONTRACTOR: u <br /> m <br /> m <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. T <br /> XI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). CO) <br /> 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. ° <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. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. f C <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERT MAY BE DONE WHEN � 0 <br /> NEEDED. o <br /> c7 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J .0 (� <br /> CONDITIONS OF PERMIT: dA �� I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYISi PERMIT R 16C> <br /> p®� <br /> ISSUANCE. 2002 <br /> II ` ill <br /> ALONG S <br /> 3. NO RA GRADING OR SH2. REMOVAL ORIORELAND NG ALTERATIONS AREOF TREES ANDIOAILLOWEDTRICTED UNLESS SPEEC F CALLY M€TT COUNTY <br /> PERMITTED. ZONING <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> l7[` z � W rWo oQov <br /> f m <br /> 6. m < 3 nm 0 Q. <br /> T' (D C N N 0 = 7� <br /> y m o -1 <br /> 7. ° m <br /> U) D <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n , n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize }(/ m m <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G) <br /> v <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> CD <br /> SIGN HERE —aA- q` <br /> (sig�nd f owner or budding co r) (date) <br /> ZONING ADMINISTRATOR t �` <br /> TOWNSHIP PERMITS MAY BE REQUIRED V <br />