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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 <br /> Office of Zo APPLICATION FOR LAND USE PERMITS Hing Administrator o 0 <br /> 3 w <br /> OVIMERkZ/' )Q / '/l / I y M Jam/ <br /> Ira( � /\, l 1 // - TELEPHONE 71 — LDS (O 3�o� l n <br /> MAILING ADDRESS 307,2a 7"'L <br /> an <br /> 0 <br /> PROPERTYADDRESS ` 0 71;I � ��c M <br /> LJ sy83C� <br /> LEGAL DESCRIPTION(see tax receipt) ,a4 3� -di 1 / �p0 HCl? a' 5 yU I <br /> TYPE OFPERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> FILLING/GRADING 11ti CAMPING UNIT ❑ SUBDIVISION ❑ c <br /> 11 <br /> STRUCTURE/ADDITIONUSE: Om n5. r <br /> (Home/--111, Commercial Business, Bedroom, Deck;etc.) ' w <br /> BUILDING CONTRACTOR: rj) � - <br /> d <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ]� <br /> T 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) C <br /> c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. In am.n p � z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). m m , <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> LAKE, STREAM S. <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF l` <br /> 4. SHOW THE LOCATION OF THE WELL WRIVER AND ESEPTIC MENT OTANK T(ST)AND DLAND ARAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES.5. P <br /> DED OR FILLED. <br /> S. IF INDICATE <br /> PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,ECON CONTRACTOR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. ' a <br /> Qj <br /> c o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT / <br /> NEEDED. � <br /> l✓ N t o v i <br /> ql2w It Er <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 1 _. <br /> CONDITIONS OF PERMIT: i( r o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE�(�� <br /> A` <br /> ISSUANCE.2. REMOVAL OR �N ' (� , t <br /> NG OF TREES AND <br /> 3. NO GRADING OR HIO ELAND ALTERATIONS ARE ALLOWED UNLESS SPEC F CALLIS RESTRICTED ALONG RYLINE.2o ,ACOvp� '(& Q <br /> PERMITTED. fV#Vd �Y <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATERqj <br /> 5. <br /> SETBACK AC <br /> PICA. <br /> 6. <br /> ter DODO L <br /> 7. 3 nm 0,a9 1 <br /> 0 y N y 0 = 3 <br /> Z m N O : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o T� O <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracyof \ q m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize c o C <br /> a ^ 0 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 a m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other i i @ <br /> authorized person to have access to the above described remises at any reasonable time for the purpose of inspection. <br /> /� E m Cn: <br /> G� m 0 : <br /> SIGN HER m 0 : <br /> m [ <br /> (signature of <br /> 9 building contractor) � <br /> ZONING ADMINISTRATOR (date)411) <br /> '69 tR 69 6A fA N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />