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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 /> .-t n95a.-9ti3 - FC8-1 g CD <br /> - <br /> OWNER L!-rt7�fLLt S CyL.R, G`f✓1 TELEPHONE 715 32-7 Li Og% d � Q <br /> MAILING ADDRESS V(I V C MPS 8 <br /> r � <br /> 0 <br /> PROPERTYADDRESS <br /> 5�.-nar 2� �c+� 3 �t• � <br /> LEGAL DESCRIPTION(see tax receipt) l ci —7 (D <br /> y� 0 <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE Ili ADDITION ❑ C/) <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT 11 SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: DECK J�Y X � 'Y ° <br /> 0 <br /> (Home/Cabin; C mmercial Business;Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: t�IA d <br /> 12 � <br /> v <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O (D <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). CO) 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �SN v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Q <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. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAy "EN <br /> jj <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. l� I/✓ 1 0 Ir <br /> CONDITIONS OF PERMIT: <br /> 1, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE 4 `v03 / to <br /> 3. NO GRADING OR 2. REMOVAL ORIO ELAND ALTERATIONS ARE ALLOWED UNLESS SPEC F CALLY OF TREES AND VEGETATION IS RESTRICTED ALONG �ZCN/V CV Nn' <br /> H <br /> PERMITTED. G <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> m an d rDi 0 > "a <br /> 6. 3 CLM '0' 'R M <br /> (-OD co <br /> 7. Z N M O (O <br /> O T� m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)at c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm ° : w <br /> aa : v <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D o mm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- CDCD <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. fD <br /> m ° <br /> ,�, g- <br /> SIGN HERE 03 � <br /> a : <br /> (signature ofo er building contracts (date) <br /> ZONING ADMINISTRATOR <br /> to EA fA EA — N <br /> ( ] N (T N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />