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Burnett County 7410 Co. Rd.K,No. 102, Siren,W154872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> f/1 <br /> N <br /> C \i <br /> OWNER CL NrV G. rV��/�LEPHONE l` lc;L 0 <br /> MAILING ADDRESS 'tedl- � � u / d e &Q y �[/n 0+moi we ` / <br /> PROPERTY ADDRESS Jr- O �/ kl!qbi4 Pd <br /> �C/ <br /> LEGAL DESCRIPTION(see tax receipt) L 3 CS V /O /1� Ch <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ `CCAMPING UNIT ❑ SUBDIVISION ❑ U.) n <br /> STRUCTURE/ADDITION USE: �_ J/ 1 0_ /a X o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) w P , <br /> m <br /> BUILDING CONTRACTOR: 52/tc_H <br /> Z �J � <br /> C <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. r <br /> O <br /> ZI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O `m 41:71 <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 0 Q' A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF CJ i <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 ` 1 <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, STC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. \ I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION AY BE I�O4�IIIFfEN o o <br /> NEEDED. 'w <br /> ;A <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. n� y�L ✓� o LU <br /> CONDITIONS OF PERMIT: CT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 9tiF� 9 <br /> ISSUANCE.2. REMOVAL OR V1 <br /> 3. NO GRADING OR HIO ELAND ALTERATIONS ARE ANG OF TREES AND LLOWED UNLESS SPECIFICALLY IS RESTRICTED ALONG ORLINE�O/I/�A^cO A Q <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m d0r' 0,0af m <br /> 3 'am x ;' M <br /> 7 'O D C y N 0 3 <br /> Z H D O 0 <br /> O IZt <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my _y A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ` m Et o 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 I am d <br /> providing in this application. 1 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. cn <br /> ? <br /> m o : <br /> SIGN HERE cn <br /> (sig re owner or buildin ontractor) (date) Q <br /> tel.! <br /> ZONING ADMINISTRATOR <br /> QfA fA ffl fA � N <br /> N (TN N O O <br /> N (T <br /> TOWNSHIP PERMITS MAY BE REQUIRED C3 Ln OO <br />